The role of quantitative MRI-based prostate zonal parameters in predicting clinically significant prostate cancer

Abstract

Introduction: We aimed to investigate the clinical utility of quantitative prostatic zonal measurements on in multiparametric magnetic resonance imaging (mpMRI) for the predication of clinically significant prostate cancer (csPCa). Methods: A retrospective, single-institution study included 144 men who underwent mpMRI from 2015–2017. Prostate zone parameters were measured on mpMRI. Correlation and multivariable analysis evaluated relationship between prostate zone parameters and the presence of csPCa. Results: The mean age was 66.9±7.8 years old. The median (interquartile range [IQR]) prostate volume and prostate-specific antigen (PSA) were 51.6 ml (37.1–74.5) and 6.1 ng/ml (4.5–8.2), respectively. Men with csPCa had significantly smaller total prostate volume (TPV), transitional zone volume (TZV), and transitional zone thickness (TZT), and larger transitional zone density (TZD) compared to those without PCa; however, on multivariate variable analysis, only TZD maintained significance. TZD had a comparable area under the curve to PSA density (PSAD) and PSA (0.74 vs. 0.73 vs. 0.60, respectively). Subgroup analysis of men with PCa, PSAD and TZD were significantly higher in men with Gleason grade group (GG) ≥2 compared to those with GG <2 (p=0.002); however, this significance is not maintained on logistic regression in predicting GG. Conclusions: Quantitative features of prostate zones on MRI may aid in identifying better predictors of csPCa. Zonal-based PSA density (TZD) may be a useful marker in identifying csPCa. Further exploration is needed to understand the clinical application of larger TZV in men with csPCa compared to those with insignificant disease.