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MRI PI-RADS scoring was developed in primarily White populations, but prostate cancer differs in non-White men. We aimed to explore differences in PI-RADS calibration for Asian and Black men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This is a secondary analysis of PREVENT, a multi-institutional study of infection rates for transrectal vs. transperineal biopsy. We compared cancer detection for self-identifying Asian and Black men. We compared detection rates on a per-person basis, stratified by index PI-RADS lesion, to White men, using Fisher\u2019s exact and logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 665\/752 trial patients with PI-RADS 3-5 lesions, 88 (13%) were Black and 36 (6%) were Asian. Black men were younger at diagnosis with increased rates of overall (70% vs. 43%%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004) and clinically significant prostate cancer (60% vs. 27%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003) and Asian men had decreased rates of overall (0% vs. 47%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004) and clinically significant prostate cancer (0% vs. 27%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003) in PI-RADS 3 lesions compared to White men. On multivariable regression, Black men with PI-RADS 3\/4 lesions had higher odds of overall (OR 1.17,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009) and clinically significant prostate cancer (OR 1.20,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004) and Asian men had lower odds of overall (OR 0.79,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.01) but not clinically significant prostate cancer (OR 0.94,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.5).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Black men with PI-RADS 3\/4 lesions had 20% higher odds of clinically significant prostate cancer than White men while all PI-RADS 3 lesions in Asian men were negative. These findings suggest PI-RADS may require differential interpretation when assessing prostate cancer risk in non-White men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      Registered at ClinicalTrials.gov (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT04843566\" ext-link-type=\"uri\">NCT04843566<\/jats:ext-link>\n                      ,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT04843566\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT04843566<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41391-025-01057-5","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T06:27:34Z","timestamp":1764138454000},"page":"435-439","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating PI-RADS lesions and clinically significant prostate cancer in Black and Asian men: a PREVENT randomized clinical trial secondary analysis"],"prefix":"10.1038","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-6145","authenticated-orcid":false,"given":"Conor B.","family":"Driscoll","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0700-7200","authenticated-orcid":false,"given":"Nicole","family":"Handa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell M.","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam B.","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim C.","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0699-1899","authenticated-orcid":false,"given":"Edward M.","family":"Schaeffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"1057_CR1","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.eururo.2019.08.005","volume":"77","author":"MB Culp","year":"2020","unstructured":"Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. 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