To guide biopsy decision making via a predictive model for clinically significant prostate cancer (csPCa) in men with positive imaging (PI-RADS 3-5). We aim to elucidate the influence of zone in the predictive accuracy of PI-RADS v2.
1, establish a threshold of quantified apparent diffusion coefficient (ADC) values suspicious for csPCa, and create a logistic-regression model, unique in its inclusion of lesion zone and quantified ADC.
Data was retrospectively collected from a single cancer center, with institutional review board review and exemption waiver, on a lesion level retrospective analysis of prostate multiparametric magnetic resonance imaging (mpMRI) of N=429 men, harboring N=546 lesions. MRI's were read and reviewed by a fellowship trained genitourinary/abdominal imaging radiologist. Pathologic analysis was conducted by a fellowship trained genitourinary pathologist. All statistical analysis including predictive modeling were conducted by an expert biostatistician.
On multivariate analysis, zone (PZ as compared to TZ) was a predictor of csPCa (OR 2.58, 95% CI 1.50-4.44, p<0.0005). A 700µm2/s ADC value cutoff in isolation had an AUC of 0.56, but our combined model, bolstered by clinical and imaging data, including zone and prostate specific antigen density, yielded an AUC of 0.78, at an ADC value cutoff of 947 µm2/s. In application, simulated scenarios yielded probabilities between 16% and 82%, therefore above a biopsy omission threshold of 10% or less.
Prostate zone and ADC value quantification each independently contribute to csPCa predictability, but no simulated use of the model yielded biopsy-omission thresholds for patients with MRI visible lesions.
Urology. 2026 Jan 28 [Epub ahead of print]
Rani Ashouri, Penny S Reynolds, Shay Rajavel, Kunal Hanchate, William Snead, John M DiBianco, Jason Joseph, Paul Crispen, Padraic O'Malley, Joseph R Grajo, Sara M Falzarano, Thomas F Stringer, Li-Ming Su, Christopher J Weight, Tarik Benidir
University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., University of Florida, Department of Anesthesiology. Gainesville, FL. Electronic address: ., University of Florida, College of Medicine. Gainesville, FL. Electronic address: ., University of Florida, College of Medicine. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: padraic.o'., University of Florida, UF Health, Department of Urology. Gainesville, FL; University of Florida, UF Health, Department of Radiology. Gainesville FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL; University of Florida, UF Health, Department of Pathology, Immunology and Laboratory Medicine. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: ., Glickman Department of Urology, Cleveland Clinic. Cleveland, OH. Electronic address: ., University of Florida, UF Health, Department of Urology. Gainesville, FL. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41616920