Association Between Tumor Multifocality on Multi-parametric MRI and Detection of Clinically-Significant Prostate...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer detection relies on accurate interpretation of multi-parametric magnetic resonance imaging (mpMRI).
• Prostate Imaging-Reporting and Data System (PI-RADS) 4 lesions require careful evaluation due to their intermediate suspicion for malignancy.
• Understanding factors influencing cancer detection in PI-RADS 4 lesions is crucial for biopsy decisions.

Purpose of the Study:

• To determine if multifocality on mpMRI influences the detection rate of clinically significant prostate cancer (Grade Group [GG] ≥ 2) in PI-RADS 4 lesions.
• To compare cancer detection rates across different configurations of PI-RADS 4 lesions and other identified lesions.

Main Methods:

• Retrospective analysis of patients with at least one PI-RADS 4 lesion undergoing mpMRI-ultrasound fusion prostate biopsy.
• Patients were categorized into four cohorts based on the presence and characteristics of PI-RADS 4 lesions and other lesions (PI-RADS 2, 3, or 5).
• Comparison of GG ≥ 2 pathology detection rates in PI-RADS 4 lesions between cohorts, with evaluation of associated clinical and radiological factors.

Main Results:

• The overall detection rate of GG ≥ 2 pathology in PI-RADS 4 lesions was 35.2%.
• Detection rates varied significantly by cohort: 21.7% (cohort 1), 36.3% (cohort 2), 49.1% (cohort 3), and 42.7% (cohort 4).
• Multivariable analysis identified age, clinical stage T2, prostate-specific antigen density, peripheral zone location, and specific study cohorts as significant predictors of GG ≥ 2 detection.

Conclusions:

• Approximately 35% of PI-RADS 4 lesions yield Grade Group ≥ 2 pathology upon targeted biopsy.
• The likelihood of detecting significant prostate cancer in PI-RADS 4 lesions is influenced by lesion location, multifocality, and the PI-RADS classification of co-existing lesions.