Zonal origin combined with IVIM parameters could predict ISUP risk groups of prostate cancer.

OBJECTIVES

To investigate the value of combining zonal origin with intravoxel incoherent motion (IVIM) parameters in predicting the International Society of Urological Pathology (ISUP) risk groups of prostate cancer.

METHODS

The retrospective study enrolled 351 prostate cancer patients who underwent mpMRI including IVIM. Patients were stratified into low-risk and high-risk group according to ISUP grades, and divided into peripheral zone (PZ) and transition zone (TZ) cancer group according to zonal origins of lesions. Clinicopathological characteristics and IVIM-derived parameters between groups were compared. Logistic regression was performed to identify variables associated with ISUP high-risk group. The predictive accuracy of the variables for ISUP risk groups was evaluated using receiver operating characteristic (ROC) analysis.

RESULTS

PZ cancers exhibited higher proportion of pathological stage ≥pT3 (P = .0184) and ISUP grade 3-5 (P < .0001), and demonstrated lower Dmean, ADCmin, and ADCmean (P = .0209, P = .0160, P = .0302) than TZ cancers. There was significant differences in zonal origin, Dmean, ADCmin, and ADCmean between the 2 ISUP risk groups (P < .0001, P < .0001, P = .0024, P = .0017). Zonal origin, prostate-specific antigen (PSA), Dmean, and ADCmin were identified as independent predictors of ISUP high-risk disease. The comprehensive model combining zonal origin, PSA, Dmean, and ADCmin demonstrated superior predictive performance (AUC = 0.956, 95% CI: 0.930-0.981) with a sensitivity of 90.63% and a specificity of 76.04%.

CONCLUSIONS

The combined diagnostic model demonstrates high efficiency for predicting the ISUP risk group preoperatively for prostate cancer.

ADVANCES IN KNOWLEDGE: The multiparameter predictive model including anatomical zones offers a non-invasive and effective tool for preoperative risk stratification for prostate cancer, thereby improving decision-making precision, and reducing unnecessary invasive procedures.