{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:11:01Z","timestamp":1785409861187,"version":"3.56.0"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"crossref","award":["SUBZ.C090.25.095"],"award-info":[{"award-number":["SUBZ.C090.25.095"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"crossref"}]},{"award":["SUBZ.C090.25.095"],"award-info":[{"award-number":["SUBZ.C090.25.095"]}],"id":[{"id":"https:\/\/ror.org\/01qpw1b93","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Clinical staging based on digital rectal examination is imprecise, leading to pathological upstaging in patients with prostate cancer (PCa). Accurate preoperative assessment remains a challenge despite the use of multiparametric magnetic resonance imaging (mpMRI) and fusion-guided biopsy. This study aims to identify key predictors of upstaging in preoperative patients. Materials and Methods: A retrospective analysis of 924 patients who underwent radical prostatectomy between July 2012 and January 2025 was performed. Variables included prostate-specific antigen, prostate volume, biopsy type, MRI, body mass index and age. Upstaging was defined as \u2265pT3 in patients staged clinically as cT1\u20132. Optimal cut-offs for continuous variables were defined statistically. Multivariable logistic regression was applied to identify independent predictors of upstaging and minor staging upgrading (MSU)\u2014defined as any upward shift in the pathological T stage relative to the clinical T stage. Model performance was evaluated using the area under the Receiver Operating Characteristic (ROC) curve (AUC). Results: Upstaging occurred in 31.9% and MSU in 50.6% of patients. The mean age was 65 years. Cut-off values for PSA density (PSAD) were 0.29 for upstaging and 0.28 for MSU. In the full-cohort model (AUC = 0.628), PSAD (odds ratio (OR) = 2.55), age (OR = 1.04), and hypertension (HT) (OR = 1.47) were associated with upstaging. In PIRADS-based models, PIRADS 5 and PSAD predicted both upstaging (OR = 1.62 and 6.10, respectively; AUC = 0.664) and MSU (OR = 1.75 and 4.67, respectively; AUC = 0.659). MSU was also associated with HT and a lack of fusion biopsy (AUC = 0.622). Conclusions: PSAD and PIRADS 5 lesions are strong determinants of pathological upstaging and MSU in PCa. These factors should be considered in preoperative risk stratification to improve staging accuracy. Despite advances in imaging and biopsy techniques, upstaging remains a common phenomenon, underlining the need for further refinement of diagnostic protocols.<\/jats:p>","DOI":"10.3390\/cancers18081319","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T16:10:44Z","timestamp":1776787844000},"page":"1319","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["PSA Density and PIRADS 5 Lesions as Key Determinants of Upstaging After Radical Prostatectomy"],"prefix":"10.3390","volume":"18","author":[{"given":"Patryk","family":"Patrza\u0142ek","sequence":"first","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2470-7996","authenticated-orcid":false,"given":"Miko\u0142aj","family":"Kisia\u0142a","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5297-3507","authenticated-orcid":false,"given":"Marcel","family":"Dawidowicz","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1569-5613","authenticated-orcid":false,"given":"Jakub","family":"Wieland","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3809-3642","authenticated-orcid":false,"given":"Karol","family":"Zag\u00f3rski","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4441-1877","authenticated-orcid":false,"given":"Jakub","family":"Karwacki","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"},{"name":"Department of Pathophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9711-6709","authenticated-orcid":false,"given":"Adam","family":"Gurwin","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"\u0141aszkiewicz","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1073-0797","authenticated-orcid":false,"given":"Wojciech","family":"Tomczak","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Urba\u0144ski","sequence":"additional","affiliation":[{"name":"Clinical Department of Rheumatology and Internal Diseases, Institute of Internal Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawid","family":"Janczak","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Krajewski","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Szyde\u0142ko","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5933-3753","authenticated-orcid":false,"given":"Bartosz","family":"Ma\u0142kiewicz","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"},{"name":"University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","unstructured":"Cornford, P., van den Bergh, R.C.N., Eberli, D., De Meerleer, G., De Santis, M., Gillessen, S., Henry, 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