Prevalence and grade of malignancy differences with respect to the area of involvement in multiparametric resonance imaging of the prostate in the diagnosis of prostate cancer using the PI-RADS version 2 classification

• Published in: World journal of urology 2023-08, Vol.41 (8), p.2155-2163
• Main Authors: Rodríguez-Cabello, Miguel Angel, Méndez-Rubio, Santiago, Sanz-Miguelañez, Juan Luis, Moraga-Sanz, Alvaro, Aulló-González, Carolina, Platas-Sancho, Arturo
• Format: Article
• Language: English
• Subjects: Biopsy; Classification; Diagnosis; Hypotheses; Malignancy; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Prostate; Prostate cancer; Radiation therapy; Statistical analysis; Tumors; Urology
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04466-0

Purpose The peripheral zone is histologically different from the transitional zone. The aim of this study is to analyze the differences between the prevalence and grade of malignancy of mpMRI-targeted biopsies that involve the TZ with respect to the PZ. Methods A cross-sectional study of 597 men evaluated for PC screening between February 2016 and October 2022 was conducted. Exclusion criteria were prior BPH surgery, radiotherapy, 5-alpha-reductase inhibitors treatment, UTI, mixed involvement of PZ–TZ or doubts, and central-zone involvement. Hypothesis contrast test was used to study differences proportions of malignancy (ISUP > 0) and significant (ISUP > 1) and high-grade tumor (ISUP > 3) in PI-RADSv2 > 2-targeted biopsies in PZ with respect to TZ, and logistic regression and hypothesis contrast tests were used to study the influence of the area of exposure as an effect-modifying factor in the diagnosis of malignancy with respect to the PI-RADSv2 classification. Results 473 patients were selected and 573 lesions biopsied (127 PI-RADS3, 346 PI-RADS4 and 100 PI-RADS5). A significant increase was described in the proportion of malignancy and significant and high-grade tumor in PZ compared to TZ (22.6%, 21.3%, and 8.7%, respectively). Significant increase in proportions and malignancy were described in cores targeted to PZ with respect to TZ, highlight the differences between PZ and TZ for ST (37.3%vs23.7% for PI-RADS4, 69.2%vs27.3% for PI-RADS5, respectively). Statistically significant linear trend was described increasing for malignancy, significant and high-grade tumors with respect to the PI-RADSv2 scores (change > 10%). Conclusion Although the prevalence and grade of malignancy in the TZ is lower than in the PZ, PI-RADS4 and 5-targeted biopsies should not be omitted in this location, but PI-RADS3 could be.