Abstract：
BACKGROUND: 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. A total of 113 PCa patients whose bpMRI data indicated that the lesions located in only 1 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 < .01). The zonal heterogeneity could independently predict the HR group patients (OR: 5.170 [1.663-16.067], P = .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.
METHODS: This prospective study was conducted from January 2019 to February 2023. A total of 113 PCa patients whose bpMRI data indicated that the lesions located in only 1 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 < .01). The zonal heterogeneity could independently predict the HR group patients (OR: 5.170 [1.663-16.067], P = .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.
摘要：
背景：位于外周区（PZ）和移行区（TZ）的前列腺癌（PCa）表现出不同的临床和病理特征。本文旨在初步评估bpMRI定量评估的PCa区域异质性与原发性病变的病理风险分层之间的关系。
方法：这项前瞻性研究于2019年1月至2023年2月进行。总共选择了113例PCa患者，其bpMRI数据表明病变仅位于前列腺的1个单个区域。进行经直肠超声和MRI靶向活检以验证bpMRI结果，活检后3周行根治性前列腺切除术(RP)。高危（HR）组定义为ISUP≥3级。进行二元回归以评估区域异质性是否可以作为HR组的独立预测因子。采用受试者操作特征(ROC)曲线分析区域定位对预测HR组的附加价值。
结果：PSA，T分期,和ISUP等级，TZPCa手术切缘阳性的发生率明显较低，和ADCmin，TZPCa中的ADC平均值明显更高（所有P<0.01）。区域异质性可以独立预测HR组患者(OR:5.170[1.663-16.067]，P=.005）并提高HR患者的预测效率（AUC0.824，95％CI，0.741-0.889）。
结论：BpMRI可以准确定量评估PCa的区域异质性，提高HR患者的预测疗效。为临床个体化治疗提供更好的帮助。
方法：这项前瞻性研究于2019年1月至2023年2月进行。总共选择了113例PCa患者，其bpMRI数据表明病变仅位于前列腺的1个单个区域。进行经直肠超声和MRI靶向活检以验证bpMRI结果，活检后3周行根治性前列腺切除术(RP)。高危（HR）组定义为ISUP≥3级。进行二元回归以评估区域异质性是否可以作为HR组的独立预测因子。采用受试者操作特征(ROC)曲线分析区域定位对预测HR组的附加价值。
结果：PSA，T分期,和ISUP等级，TZPCa手术切缘阳性的发生率明显较低，和ADCmin，TZPCa中的ADC平均值明显更高（所有P<0.01）。区域异质性可以独立预测HR组患者(OR:5.170[1.663-16.067]，P=.005）并提高HR患者的预测效率（AUC0.824，95％CI，0.741-0.889）。
结论：BpMRI可以准确定量评估PCa的区域异质性，提高HR患者的预测疗效。为临床个体化治疗提供更好的帮助。
