Abstract
The current diagnostic modality of prostate cancer based on prostate specific antigen (PSA) and systematic biopsy is far from ideal in terms of over-diagnosing indolent prostate cancer and missing significant ones. Thus we integrated the peripheral zone volume ratio (PZ-ratio) for diagnostic refinement. This retrospective study included 247 consecutive patients who underwent initial transrectal ultrasound-guided systematic prostate biopsy from April 2014 to November 2015. Prostate volume was determined by semi-automatic contour on axial T2 weighted magnetic resonance imaging (MRI). PZ-ratio was inversely correlated with age (r = −0.36, p <0.0001). Adding PZ-ratio and MRI findings to the current predictive model (age, PSA density, percent-free PSA) significantly increased diagnostic accuracy in all patients (AUC: 0.871 vs. 0.812, p = 0.0059), but not in patient subgroup with PSA 4–10 ng/ml (AUC: 0.863 vs. 0.803, p = 0.12). The new model also significantly reduced the number of unnecessary biopsies while missing less significant cancers at a probability threshold of 25%. PZ-ratio is a potential tool in predicting biopsy results, and when added alone or in combination with MRI findings, the diagnostic accuracy can be further enhanced.
Highlights
The random nature of transrectal ultrasound (TRUS) guided systematic prostate biopsy sampling and low specificity of prostate specific antigen (PSA) have induced overtreatment of clinically indolent prostate cancer (PCa) and missed diagnosis of significant ones [1]
The causal role between benign prostatic hyperplasia (BPH) and PCa is yet to be clarified, enlargement of an aging prostate due to BPH is typically contributed by the transition zone (TZ), while peripheral zone (PZ) is typically considered as age-irrelevant [12]
The purpose of the current study was to validate the diagnostic value of PZ-ratio (i.e., PZ volume divided by prostate volume) based upon contoured volume in axial T2 fat saturated MR images, and to evaluate whether incorporating this parameter provides any additional benefit in the current diagnostic modality in detecting clinically significant PCa
Summary
The random nature of transrectal ultrasound (TRUS) guided systematic prostate biopsy sampling and low specificity of prostate specific antigen (PSA) have induced overtreatment of clinically indolent prostate cancer (PCa) and missed diagnosis of significant ones [1]. PV estimation by contoured MR images is regarded as the most precise noninvasive method available [11]. Previous studies using the contoured method on MRI have observed significant correlation between central gland volume fraction and Gleason Score [18], and can better distinguish PCa patients [19]. These studies have a relatively small sample size with no further stratification of patients with PSA level of 4–10 ng/ml, and did not perform multivariate correlation analyses.
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