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Submission Status
Submitted
Abstract
Abstract Title
MRI prostate accuracy when estimating ISUP Grade Groups compared to radical prostatectomy ISUP grading: A biobot database in a regional center.
Presentation Type
Podium Abstract
Manuscript Type
Clinical Research
Abstract Category *
Oncology: Prostate
Author's Information
Number of Authors (including submitting/presenting author) *
4
No more than 10 authors can be listed (as per the Good Publication Practice (GPP) Guidelines).
Please ensure the authors are listed in the right order.
Country
Australia
Co-author 1
Matthieu Mo bryanjmo@gmail.com Toowoomba Hospital Urology Toowoomba Australia *
Co-author 2
Nikhil Sapre Nikhil.Sapre@health.qld.gov.au Toowoomba Hospital Urology Toowoomba Australia -
Co-author 3
Jacob Gleeson jacob.gleeson@health.qld.gov.au St Vincent's Hospital Urology Toowoomba Australia -
Co-author 4
Devang Desai d.desai@toowoombaspecialists.com.au Toowoomba Hospital Urology Toowoomba Australia -
Co-author 5
Co-author 6
Co-author 7
Co-author 8
Co-author 9
Co-author 10
Co-author 11
Co-author 12
Co-author 13
Co-author 14
Co-author 15
Co-author 16
Co-author 17
Co-author 18
Co-author 19
Co-author 20
Abstract Content
Introduction
Accurate preoperative risk stratification in prostate cancer is vital for guiding treatment. The ISUP grade helps distinguish low-risk (ISUP 1–2) from high-risk (ISUP 3–5) disease, informing clinical decisions. Multiparametric MRI of the prostate (MRIp) is a key non-invasive tool for assessing tumor aggressiveness. However, discrepancies between MRIp-assigned ISUP grades and final pathology from radical prostatectomy (RP) can result in disease misclassification. This study evaluates MRIp accuracy in estimating ISUP groups. Previous publications aimed at MRIp accuracy only compare MRI and biopsy accuracy, not noting ISUP groups specifically. Other recent prospective studies focusing on MRI accuracy only focus on ISUP 1 groups and the risk of needing an upgrade in grading.[4]. Studies regarding ISUP grading accuracy in low risk compared to high risk were not compared in the last 10 years.
Materials and Methods
A retrospective review was conducted using the Biobot database, including patient-level data on MRI prostates from October 2022 to February 2025, targeted biopsy, and RP outcomes. Key variables included PSA, prostate volume, lesion size, MRI PIRADS, and imaging-pathology concordance. ISUP grades were grouped into low-risk (1–2) and high-risk (3–5). The primary measure was MRI-assigned ISUP compared to final RP grade, with frequency and percentage distribution of accuracy categories. Subgroup analysis was performed to assess MRIp performance across risk groups.
Results
In a cohort of 56 patients, ISUP grades assigned by multiparametric MRI (MRIp) were compared to final radical prostatectomy (RP) pathology. MRIp grading was accurate in 47 patients (84%), underestimated in 6 (11%), and overestimated in 3 (5%). A significant difference was found between MRIp and RP ISUP groups (p < 0.001), revealing discrepancies despite strong overall performance. Underestimation mainly affected high-risk cancers (ISUP 3–5), often misclassified as ISUP 2. The average upgrade in underestimated cases was 1.5 ISUP points. Overestimation typically involved MRIp-assigned ISUP 3 downgraded to 2 or 1, with an average drop of 1.0 point. MRIp is generally accurate in low-risk disease but may under-stage aggressive tumors, supporting the need for multimodal evaluation in risk stratification.
Conclusions
MRIp shows strong overall accuracy in ISUP grading, particularly for low-risk prostate cancer, but its limitations in high-grade disease highlight the need for multimodal evaluation strategies to improve diagnostic precision
Keywords
Prostate Biopsy, biobot, MRI prostate, PSMA PET
Figure 1
https://storage.unitedwebnetwork.com/files/1237/b51b685ecee42b54613f7f73de9d3786.png
Figure 1 Caption
MRIp Accuracy with ISUP Grade Change
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Character Count
2274
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