Evaluating PI-RADS Lesions in Black and Asian versus White Men

This study investigated potential racial differences in how effectively MRI PI-RADS scoring predicts prostate cancer, noting that the system was originally developed using predominantly White patient populations. Using data from the multi-institutional PREVENT trial, the researchers conducted a secondary analysis of 665 men with PI-RADS 3–5 lesions, including 88 Black men and 36 Asian men, and compared their cancer detection rates to those of White men. The analysis showed that Black men were diagnosed at younger ages and had significantly higher rates of both overall prostate cancer and clinically significant disease, particularly in PI- RADS 3 and 4 lesions. For example, among men with PI-RADS 3 lesions, Black patients had markedly higher detection rates than White patients. In contrast, Asian men demonstrated much lower detection rates, with no cancers identified in PI-RADS 3 lesions and an overall lower likelihood of cancer detection compared to White men. Multivariable regression analysis supported these findings, showing that Black men had increased odds of both overall and clinically significant prostate cancer, while Asian men had reduced odds of overall cancer detection and no significant difference in clinically significant cancer risk. Overall, these results suggest that PI- RADS scoring may not be uniformly applicable across racial groups and could benefit from recalibration or more nuanced interpretation to improve prostate cancer risk assessment in non-White populations.

PI-RADS is a 1-5 scoring system for prostate MRIs that helps assess the likelihood of clinically significant cancer and guides biopsy decisions. Higher scores (4-5) indicate greater suspicion.

Prostate Cancer Prostatic Dis. 2025 PMID:41298852