AI risk classification non-inferior to PI-RADS for patient-level detection of clinically significant prostate cancer on bpMRI

In 787 men, AI risk classification had patient-level sensitivity 97.6% vs PI-RADS 92.6% (p<0.001) and AUC 0.80 vs 0.77 (p=0.043) for clinically significant prostate cancer (csPCa), but lower lesion-level sensitivity (78.8% vs 88.8%). AI upgraded 93.1% of csPCa in PI-RADS 3 lesio…

• AI’s patient-level AUC was higher (difference 0.032, 95% CI 0.001–0.064), and patient-level sensitivity was non-inferior, but lesion-level sensitivity was not (78.8% vs 88.8%, p=0.98).
• A PI-RADS 3 triage strategy preserved 98.4% sensitivity while avoiding 18.9% of biopsies; AI upgraded 93.1% of csPCa-positive lesions and assigned low risk to 24.1% of benign lesions in that category.

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