Introduction: Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 recommends that lesions in the peripheral zone (PZ) are mainly assessed by diffusion-weighted imaging (DWI) and adjusted by dynamic contrast-enhanced (DCE). There are two possible images for PI-RADS 4 lesions in PZ. One is DWI 4, the other is DWI 3 with positive DCE (hereinafter called ‘DWI 3/DCE+’). Our objectives are to compare the clinically significant prostate cancer (csPCa) detection rate between DWI 4 and DWI 3/DCE+ in PZ and to explore the diagnostic performances of targeted biopsy (TB) alone or systematic biopsy (SB) alone for patients with DWI 3/DCE+.
Methods: We retrospectively enrolled 206 patients who underwent multiparametric magnetic resonance imaging and had at least one PI-RADS 4 lesion in the PZ. All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided SB. The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions. Based on the TB+SB results as a standard reference, we analyzed the sensitivity, negative predictive values, and diagnostic accuracies of TB alone or SB alone.
Results: Patients with DWI 4 lesions had higher csPCa detection rates than those with DWI 3/DCE+ lesions when using TB+SB, TB, and SB, and the differences were significant for TB+SB or SB alone. For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value.
Conclusions: Our finding suggested that DWI 4 tends to have worse results than DWI 3/DCE+. TB has an excellent ability to exclude negative csPCa in patients with DWI 3/DCE+ lesions and prostate-specific antigen levels from 4 to 10 ng/mL.
Source of Funding: The Ministry of Science and Technology of China
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