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Updated: Jun 14, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Enhancing Prostate Cancer Detection in PI-RADS 3 Cases: An In-depth Analysis of Radiological Indicators from
İlker Mersinlioğlu1, Ayse Keven1, Zülbiye Eda Tezel1
1Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Türkiye.
Abstract:
Prostate cancer (PCa) diagnosis using multiparametric magnetic resonance imaging (mpMRI) remains challenging, especially in Prostate Imaging Reporting and Data System 3 (PI-RADS 3) lesions, which present an intermediate risk of malignancy. This study aims to evaluate the diagnostic efficacy of various radiological parameters in PI-RADS 3 lesions to improve the decision-making process for prostate biopsies.This retrospective study included 76 patients with PI-RADS 3 lesions who underwent mpMRI and transrectal prostate biopsy at a tertiary university hospital between 2015 and 2022. Radiological parameters such as signal intensity, lesion size, border definition, morphological features, lesion location, and prostate volume were analyzed. Apparent diffusion coefficient (ADC) values and the patients' clinical data including age, prostate-specific antigen (PSA), and histopathological findings were also evaluated. Results: Among the 76 patients meeting the inclusion criteria, prostate cancer was detected in 17, with only one case being clinically significant (csPCa). Factors increasing malignancy risk in PI-RADS 3 lesions included poorly defined lesion borders, ADC values below 1180 μm²/sec, and prostate volume below 50.5 cc. The study highlighted the need for additional radiological and clinical parameters in the risk classification of PI-RADS 3 cases.This retrospective study included 76 patients with PI-RADS 3 lesions who underwent mpMRI and transrectal prostate biopsy at a tertiary university hospital between 2015 and 2022. Radiological parameters such as signal intensity, lesion size, border definition, morphological features, lesion location, and prostate volume were analyzed. Apparent diffusion coefficient (ADC) values and the patients' clinical data including age, prostate-specific antigen (PSA), and histopathological findings were also evaluated.Among the 76 patients meeting the inclusion criteria, prostate cancer was detected in 17, with only one case being clinically significant (csPCa). Factors increasing malignancy risk in PI-RADS 3 lesions included poorly defined lesion borders, ADC values below 1180 μm²/sec, and prostate volume below 50.5 cc. The study highlighted the need for additional radiological and clinical parameters in the risk classification of PI-RADS 3 cases.The findings suggest that incorporating additional radiological parameters into the evaluation of PI-RADS 3 lesions can enhance the accuracy of prostate cancer diagnosis. This approach could minimize unnecessary biopsies and ensure that significant malignancies are not overlooked. Future multicenter, large-scale studies are recommended to establish more definitive risk stratification criteria. · The study emphasizes the complexity of diagnosing prostate cancer in PI-RADS 3 lesions and the importance of detailed radiological assessment.. · It highlights the significance of specific radiological parameters, including lesion border definition and ADC values, in predicting malignancy.. · The research provides valuable insight for clinicians in order to make informed decisions regarding prostate biopsies, particularly in ambiguous PI-RADS 3 cases.. · Mersinlioğlu İ, Keven A, Tezel ZE et al. Enhancing Prostate Cancer Detection in PI-RADS 3 Cases: An In-depth Analysis of Radiological Indicators from Multiparametric MRI. Rofo 2025; 197: 669-681.
Insights
Diagnosing prostate cancer in PI-RADS 3 lesions is challenging. Poorly defined borders, low ADC values, and smaller prostate volume increase malignancy risk, aiding biopsy decisions.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer (PCa) diagnosis via multiparametric magnetic resonance imaging (mpMRI) is complex, particularly for Prostate Imaging Reporting and Data System 3 (PI-RADS 3) lesions.
- PI-RADS 3 lesions represent an intermediate risk of malignancy, complicating the decision for prostate biopsies.
Purpose of the Study:
- To evaluate the diagnostic efficacy of various radiological parameters in PI-RADS 3 lesions.
- To improve decision-making for prostate biopsies in cases with intermediate-risk lesions.
Main Methods:
- Retrospective analysis of 76 patients with PI-RADS 3 lesions who underwent mpMRI and biopsy.
- Evaluation of radiological parameters (lesion size, border, morphology, location, prostate volume) and apparent diffusion coefficient (ADC) values.
- Correlation with clinical data (age, PSA) and histopathological findings.
Main Results:
- Prostate cancer was detected in 17 of 76 patients; only one case was clinically significant (csPCa).
- Factors associated with increased malignancy risk included poorly defined lesion borders, ADC values < 1180 μm²/sec, and prostate volume < 50.5 cc.
Conclusions:
- Additional radiological and clinical parameters are needed for accurate risk stratification of PI-RADS 3 lesions.
- Incorporating these parameters can enhance diagnostic accuracy, minimize unnecessary biopsies, and prevent overlooking significant malignancies.
- Further multicenter, large-scale studies are recommended for definitive risk criteria.
