#1450

ADDITIVE VALUE OF PROSTATIC ZONE AND PSA DENSITY IN PIRADS FOR PREDICTING ACCURACY OF CLINICALLY SIGNIFICANT PROSTATE CANCER

D. V¹, D. M A¹, D. T¹, D. KULKARNI¹, D. PUVVADA¹, D. JAVALI¹, D. MYLARAPPA¹, D. D¹

¹RAMAIAH MEDICAL COLLEGE, UROLOGY, BENGALURU, India

Introduction:

Prostate Imaging Reporting and Data System (PI-RADS) Score V2.1 has improved the detection of clinically significant prostate cancer (csPCa). A majority of prostate cancer (PCa) arises from the Peripheral Zone (70-80%). 20- 25% of PCa arises in the TZ while 1-8% of PCa is identified in the CZ. Despite PI-RADS v2.1 consideration of zonal imaging differences, competing disease, such as BPH, mimic suspicious lesions, and pose diagnostic challenges. PSA density (PSAD), a surrogate for discerning BPH and PCa, has yet to be included in the evaluation of suspicious PI-RADS lesions.

Material and methods:

Single center retrospective review of patients (2016-2023) harboring PI-RADS 3-5 lesions who subsequently underwent prostate biopsy. CsPCa defined as Grade Group (GG) ≥ 2. Imaging and pathology reviewed by radiologist and pathologist respectively. PSAD and ADC values were stratified as ≥ 0.15 ng/mL2 vs. < 0.15 ng/mL, and ≥700 vs <700mm2/s x10-6 respectively.

Results:

PZ has a 3.2x greater chance of harboring GG2-GG5 as compared to the TZ for all PI-RADS 3-5 lesions. A PSAD cutoff of ≥.15 ng/mL 2 has a 4.76x increased risk of GG2-GG5 for all PI-RADS 3-5 lesions as compared to a PSAD.