Influence of Prostate Volume on Targeted Biopsy Outcomes and PI-RADS Predictive Value for Significant Prostate...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Multiparametric MRI (mpMRI) and Prostate Imaging Reporting and Data System (PIRADS) have improved prostate cancer (PC) detection.
• The influence of prostate volume on cancer detection rates and PIRADS accuracy needs further clarification.

Purpose of the Study:

• To evaluate how prostate volume affects the detection of clinically significant prostate cancer (CSPC) and high-risk prostate cancer (HRPC).
• To determine if prostate volume modifies the predictive performance of PIRADS scores in mpMRI-guided biopsies.

Main Methods:

• Retrospective analysis of 361 biopsy-naïve men undergoing mpMRI-fusion transperineal biopsies.
• Prostates were categorized as small (<44 mL) or large (≥44 mL) based on ROC analysis.
• Logistic regression and cubic-spline analyses assessed the relationship between prostate volume, PIRADS score, and cancer detection.

Main Results:

• Smaller prostates (<44 mL) had significantly higher detection rates for any cancer (74.3%), CSPC (42.5%), and HRPC (14.3%) compared to larger prostates.
• Small prostate volume was an independent predictor of any cancer, CSPC, and HRPC.
• PIRADS score accuracy was volume-dependent; PIRADS 3 lesions in large prostates had a low risk of CSPC (2%) and HRPC (0%).

Conclusions:

• Prostate volume is inversely correlated with prostate cancer detection rates and tumor aggressiveness.
• PIRADS performance is significantly influenced by prostate gland volume.
• PIRADS 3 lesions in large prostates may not require biopsy due to a low likelihood of significant cancer.