Magnetic resonance imaging (MRI) and its standardized reporting method, called prostate imaging-reporting and data system (PI-RADS), along with MRI/transrectal ultrasound (TRUS) fusion-targeted biopsy, have improved the accuracy of diagnosis for prostate cancer (PCa) [[1], [2], [3], [4], [5]]. However, some suspected PCa lesions based on PI-RADS are not diagnosed as PCa by MRI/TRUS fusion-targeted biopsy [6,7]. Therefore, further improvement in MRI/TRUS fusion-targeted biopsy based on PI-RADS findings in MRI is warranted.
MRI/TRUS fusion-targeted biopsy is generally performed for lesions with PI-RADS categories of 3, 4, and 5, and its accuracy for diagnosing PCa increases with higher PI-RADS categories [[7], [8], [9]]. Therefore, improving the diagnostic accuracy of PI-RADS categories 3 and 4 is essential for enhancing the overall diagnostic accuracy of MRI/TRUS fusion-targeted biopsy. PI-RADS category is primarily determined on the basis of signal intensity and shape on MRI T2-weighted images (T2WI) and diffusion-weighted images (DWI) [1]. Conversely, lesion size is considered only when differentiating between PI-RADS 4 and 5, based on whether the lesion is 15 mm or larger. Therefore, incorporating lesion size into the evaluation of PI-RADS categoriy on MRI may improve the diagnostic accuracy of MRI/TRUS fusion-targeted biopsy. Additionally, the prostate volume (PV) varies significantly among patients and is believed to influence the diagnostic accuracy of MRI/TRUS fusion-targeted biopsy [10]. Hence, we considered that examining the lesion size-to-PV ratio could enhance the overall diagnostic accuracy of MRI/TRUS fusion-targeted biopsy.
The current study aimed to investigate the impact of TD/PV on predicting PCa and clinically significant (cs) -PCa in MRI/TRUS fusion-targeted biopsy based on the finding of PI-RADS on MRI and constructed the predictive nomograms for PCa and csPCa in patients with suspected PCa and PI-RADS category 3–5 lesions by combining TD/PV and PI-RADS category.
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