ISUP Grade Group Migration Between Prostate Biopsy and Radical Prostatectomy: A Systematic Review of Emerging Predictors.
Authors
Affiliations (9)
Affiliations (9)
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
- Department XV, Discipline of Radiology and Medical Imaging, University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania.
- Department of Urology and Surgical Nephrology, Nicolae Testemitanu State Medical and Pharmaceutical University, Stefan cel Mare si Sfant Boulevard, No. 165, MD-2004 Chisinau, Moldova.
- Department of Medicine, Discipline of Radiology, Vasile Goldiş Western University, Liviu Rebreanu Boulevard, No. 86, 310414 Arad, Romania.
- Department of Surgery 1, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
- Department VIII, Discipline of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
Abstract
<b>Background/Objectives</b>: International Society of Urological Pathology (ISUP) Grade Group discordance between prostate biopsy and radical prostatectomy (RP) affects 25-50% of men with localized prostate cancer and has direct implications for active surveillance, nerve-sparing, and adjuvant-treatment decisions. We synthesized contemporary evidence on the frequency of biopsy-to-RP grade migration and on emerging imaging, molecular/genomic, and artificial-intelligence (AI)-based predictors of migration. <b>Methods</b>: MEDLINE (PubMed) was searched from 1 January 2010 to 5 May 2026, supplemented by citation searching of recent systematic reviews. Eligible studies reported paired biopsy-RP pathology under the modified 2005 Gleason or the 2014/2019 ISUP Grade Group system, with ≥50 paired cases. Risk of bias was assessed with QUIPS, PROBAST, and QUADAS-2; certainty of evidence was rated with a GRADE framework adapted for prognostic research. Synthesis followed the SWiM reporting guidance. <b>Results</b>: Thirty-seven primary studies and eight prior systematic reviews were included. Concordance ranged from 44% to ~70%, upgrading from 14% to 67%, and downgrading from 5% to 26%. Biopsy GG1 disease showed the highest absolute upgrading risk (55-67%). Four predictors reached moderate GRADE certainty: PI-RADS category, biopsy approach (combined vs. systematic), PSMA-PET maximum standardized uptake value, and PSA density (PSAD). Cribriform/intraductal carcinoma at biopsy, the Decipher genomic classifier, the Prostate Health Index, and machine-learning and radiomics models reached very low certainty; clinical nomograms reached low certainty; germline alterations as direct predictors reached very low certainty. PROBAST flagged the analysis domain as high risk in five of eight prediction-model studies, and only one of eight models was externally validated. <b>Conclusions</b>: Despite a decade of refinements in grading, imaging, biopsy technique, and molecular profiling, biopsy-to-RP grade discordance remains substantial. Contemporary evidence supports incorporating PI-RADS, biopsy approach, and PSAD into shared decision-making; emerging molecular and AI-based predictors require prospective external validation in adequately powered, geographically representative cohorts before routine clinical adoption.