Purpose: PIRADS v2 stipulates that dynamic contrast-enhanced (DCE) imaging be used to categorize diffusion-weighted-imaging (DWI) score 3 (DWI 3) peripheral zone (PZ) lesions as PIRADS score 3 (PIRADS 3; DCE -) or PIRADS 4 (DCE +). It's controversial for the value of DCE in improving clinically significant prostate cancer (csPCa) detection. We aimed to figure out whether DCE improves csPCa detection and explore new available measures to improve csPCa detection.
Patients and methods: We retrospectively enrolled 375 patients who underwent mp MRI before MRI/ultrasound (US) fusion-targeted biopsy (TB) with transperineal systematic biopsy (SB). All lesions were classified as DWI 3/DCE -, DWI 3/DCE +, DWI 4/PIRADS 4 lesions. Detection rates of csPCa for each lesion group were analyzed. The diagnostic performance of each approach was analyzed by receiver operating characteristics (ROC) analysis and decision curve analysis.
Results: Totally, 109 DWI 3 or DWI 4 single lesions in PZ were analyzed (n = 109). The rates of csPCa detection for Group A, Group B, Group C is 10.3%, 13.9%, 55.9%, respectively (A vs. B, p = 0.625; B vs. C, p < 0.001). ROC analysis and decision curve analysis showed the method of combining Age, PSA Density (PSAD) and the mean apparent diffusion coefficient value (ADCmean) outperforms individual approaches for csPCa detection.
Conclusion: For DWI 3 lesions in PZ, DCE sequence has not additional value for improving detection of csPCa. The integration of clinical characteristics and bpMRI parameter improves the detection of csPCa.
Keywords: Biparametric MRI; Clinically significant prostate cancer; Dynamic contrast enhanced; MRI/ultrasound fusion-targeted biopsy; Mean value of apparent diffusion coefficient.