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Zonal origin combined with IVIM parameters could predict ISUP risk groups of prostate cancer
Jinman Zhong1, Zhiwen Che2, Xingru Qin1
1Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710004, PR China.
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.
Insights
Combining prostate cancer zonal origin with intravoxel incoherent motion (IVIM) parameters accurately predicts International Society of Urological Pathology (ISUP) risk groups. This noninvasive approach improves preoperative risk stratification and decision-making.
Area of Science:
- Radiology and Imaging
- Oncology
- Urology
Background:
- Accurate preoperative risk stratification is crucial for effective prostate cancer management.
- Prostate cancer exhibits distinct characteristics based on its zonal origin (peripheral zone vs. transition zone).
- Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) provides insights into tissue microstructural properties.
Purpose of the Study:
- To evaluate the combined predictive value of zonal origin and IVIM parameters for prostate cancer risk stratification.
- To assess the performance of a multi-parameter model in distinguishing between low-risk and high-risk International Society of Urological Pathology (ISUP) groups.
Main Methods:
- Retrospective analysis of 351 prostate cancer patients who underwent multiparametric MRI (mpMRI) with IVIM.
- Patients were classified into ISUP risk groups and categorized by cancer zonal origin (peripheral zone [PZ] vs. transition zone [TZ]).
- Logistic regression and receiver operating characteristic (ROC) analysis were used to identify predictors and evaluate model performance.
Main Results:
- Peripheral zone cancers showed higher rates of advanced pathological stage and higher ISUP grades compared to transition zone cancers.
- Significant differences in IVIM parameters (Dmean, ADCmin, ADCmean) and zonal origin were observed between ISUP risk groups.
- A comprehensive model combining zonal origin, prostate-specific antigen (PSA), Dmean, and ADCmin achieved high predictive accuracy (AUC = 0.956).
Conclusions:
- The integration of zonal origin and IVIM parameters offers a highly efficient method for preoperative ISUP risk group prediction in prostate cancer.
- This noninvasive multi-parameter model aids in precise preoperative risk stratification, potentially reducing the need for unnecessary invasive procedures.
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