Bi-parameter MRI Could Quantitatively Assess the Zonal Heterogeneity of Prostate Cancer

Introduction Prostate cancer (PCa) located in the peripheral zone (PZ) and transitional zone (TZ) showed a different clinical and pathological characteristic. This passage aims to preliminarily evaluate the relationship between the zonal heterogeneity of PCa quantitatively assessed by bpMRI and pathological risk stratification of the primary lesion. Methods This prospective study was conducted from January 2019 to February 2023. 113 PCa patients whose bpMRI data indicated that the lesions located in only one single zone of the prostate were selected. A transrectal ultrasound and MRI-targeted biopsy were performed to verify the bpMRI results, and then radical prostatectomy (RP) was performed in 3 weeks after the biopsy. The high-risk (HR) group was defined as ISUP grades ≥3. Binary regression was performed to evaluate if the zonal heterogeneity could be an independent predictor of the HR group. The receiver operator characteristic (ROC) curve was performed to analyze the added value of zonal location in predicting the HR group. Results PSA, T staging, and ISUP grades, incidence of positive surgical margins were significantly lower in the TZ PCa, and the ADCmin, and ADCmean values in the TZ PCa were significantly higher (all P< 0.01). The zonal heterogeneity could independently predict the HR group patients (OR: 5.170 [1.663ཞ16.067], P=0.005) and improve the predicting efficiency of HR patients (AUC 0.824, 95%CI: 0.741∼0.889). Conclusions BpMRI could quantitively assess the zonal heterogeneity of PCa precisely and increase the predicting efficacy of HR patients, which can provide better help for clinical individualized treatment. Micro-Abstract It has not been discussed that whether bi-parameter MRI (bpMRI) could be a detector of prostate cancer (PCa) zonal heterogeneity. The prospective-multicenter study recruited 113 peripheral zone (PZ)-only or transitional zone (TZ)-only PCa patients diagnosed by bpMRI. PZ-located patients showed a malignant clinical-pathological character. PZ-located lesion diagnosed by bpMRI could help predict the ISUP≥3 patients. BpMRI could precisely detect PCa zonal heterogeneity quantitively.