“…Decipher scores were significantly higher in mpMRI-visible lesions (mean difference 0.22, 95% CI 0.13-0.32; P < 0.001), indicating an enrichment of genes associated with high-risk prostate cancer (in this case, elevated risk of early metastatic spread) in mpMRI-visible disease; however, in this study, they did not control for the dominant effect that tumour grade and size has on mpMRI visibility. Similar findings were confirmed by Houlahan et al [4], who took a cohort of men who underwent RP (n = 40), defining tumours as mpMRI-visible (PI-RADSv2 score 5) or mpMRI-invisible (PI-RADSv2 score 1-2). Unlike Purysko et al [3], they stipulated inclusion of only 'clinically significant' cancer (using their definition of Gleason score 3+4 with a minimum tumour diameter of 1.5 cm).…”