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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

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Abstract

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.

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Abbreviations

DRE:

Digital rectal examination

PI-RADSv2:

Prostate Imaging and Data System version 2

mpMRI:

Multiparametric prostate MRI

ST:

Significant tumor

PC:

Prostate cancer

PZ:

Peripheral zone

TZ:

Transitional zone

ADT:

Androgen deprivation therapy

UTI:

Urinary tract infection

BPH:

Benign prostate hyperplasia

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Acknowledgements

This study is an important part of a research project and constitutes a key element in the presentation of the main author's doctoral thesis. The authors acknowledge the Methodology and Statistics staff of the Francisco de Vitoria University (Madrid, Spain) for the assistance given in the methodology and statistical analysis of this manuscript, and to our radiologist and urologist colleagues for their unrelenting and unbeatable healthcare work and help to carry out this study.

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Authors and Affiliations

  1. Department of Urology, Hospital Universitario Sanitas La Moraleja. Avenida de Francisco Pi Y Margall 81, 28050, Madrid, Spain

    Miguel Angel Rodríguez-Cabello, Santiago Méndez-Rubio, Juan Luis Sanz-Miguelañez, Alvaro Moraga-Sanz & Arturo Platas-Sancho

  2. Department of Radiology, Hospital Universitario Sanitas La Moraleja. Avenida de Francisco Pi Y Margall 81, 28050, Madrid, Spain

    Carolina Aulló-González

  3. Universidad Francisco de Vitoria. Carretera Pozuelo a, Av de Majadahonda, Km 1.800, 28223, Madrid, Spain

    Miguel Angel Rodríguez-Cabello, Santiago Méndez-Rubio, Juan Luis Sanz-Miguelañez, Alvaro Moraga-Sanz, Carolina Aulló-González & Arturo Platas-Sancho

Authors
  1. Miguel Angel Rodríguez-Cabello
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  2. Santiago Méndez-Rubio
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Contributions

All authors have contributed to the study and its design, as well as to its revision and correction. Likewise, all authors have approved this version of the submitted article. MARC: protocol and project development, data collection, data analysis, manuscript writing. SMR: data analysis, manuscript writing and editing. JLSM: data collection, data analysis, manuscript editing. AMS: data collection, data analysis, manuscript writing. CAG: data collection, data analysis, manuscript editing. APS: manuscript editing, other (resources, supervision, validation, visualization). All authors whose names appear on the submission agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Finally, all authors declare no conflict of interest with any related company or institution.

Corresponding author

Correspondence to Miguel Angel Rodríguez-Cabello.

Ethics declarations

Approval of the research protocol by an institutional reviewer board

This study corresponds to the research project (39/2021), which has been evaluated in its methodological, ethical and legal aspects in the Research Ethics Committee session of the Francisco de Vitoria University (Madrid, Spain) on 7th July 2021, getting a favorable resolution.

Conflict of interest

All authors declare no conflict of interest with any related company or institution.

Informed consent

N/A. The study does not imply risk to patients and a direct benefit is not expected. However, the knowledge gained from the study can help medical progress. Given the nature of the study, being cross-sectional and retrospective, and the absence of intervention in the patient, the exemption of informed consent has been enabled. It is guaranteed with the commitment of confidentiality.

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Rodríguez-Cabello, M.A., Méndez-Rubio, S., Sanz-Miguelañez, J.L. et al. 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. World J Urol 41, 2155–2163 (2023). https://doi.org/10.1007/s00345-023-04466-0

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