Abstract
EVALUATION OF TRANSITIONAL ZONE LESIONS ON MULTIPARAMETRIC MRI AND MRI-TARGETED BIOPSY IN DETECTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN THE COMMUNITY SETTING: A RETROSPECTIVE STUDY
Urologic oncology, v 42, pp S101-S102
Mar 2024
Abstract
MRI is the most accurate diagnostic imaging tool for detecting clinically significant prostate cancer (PCa).; PCa occurs mainly in the peripheral zone (PZ); although around 30% of malignancy occurs in the transitional zone (TZ). Lesions in the TZ are difficult to biopsy and challenging for radiologists to characterize with various confounding differentials, notably benign prostatic hyperplasia. The purpose of this study is to retrospectively compare the diagnostic yield and pathologic outcomes of TZ lesions compared to PZ lesions in the non-academic setting.
Retrospective review of MRI fusion biopsies performed at multiple institutions from 2020-2022. PI-RADS 3 (P3), 4 (P4), and 5 (P5) lesions were included. Inclusion criteria were men ≥18 years of age, who underwent mpMRI for clinically suspected prostate cancer or with previously diagnosed prostate cancer on active surveillance at the time of biopsy. Exclusion criteria were patients who received previous local therapy for prostate cancer, and prostates categorized as PI-RADS <3. Patient characteristics including age, ethnicity, family history of PCa, prostate size, lesion size, lesion location (TZ vs PZ), radiologist, and eventual treatment of positive biopsy findings were recorded.; Clinically significant PCa was defined as Gleason group grade 2-5.
There were 456 PZ lesions and 81 TZ included in the cohort. The PZ lesions included 71 (15.6%) P5, 264 (57.9%) P4, and 121 (26.5%) P3 lesions.; There were 25 (30.9%) P5, 21 (25.9%) P4, and 35 (43.2%) P3 lesions in the TZ group.; The TZ had a higher proportion of P5 lesions (30.9% vs 15.6%, P=0.009) and P3 lesions (43.2% vs 26.5%, P=0.002), but fewer P4 lesions (25.9% vs 57.9%).; The TZ P4 lesions demonstrated higher rates of clinically significant PCa detection compared to PZ lesions (42.9% vs 31.8%, P=0.023).; Further, TZ P4 lesions result in less benign pathology (42.9% vs 66.7%, P=0.028).; There was no difference in P5 or P4 lesions between the two groups in regard to the detection of clinically significant cancer.; There was also no difference in finding higher-grade group cancer on standard template biopsy vs MRI-identified lesions for any TZ or PZ lesions.
P4 TZ lesions demonstrated higher rates of detecting clinically significant prostate cancer when compared to P4 PZ lesions in our community setting.; We conclude that both urologists and radiologists should continue to analyze and target transitional zone lesions with the same consideration given to peripheral zone lesions.
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- Title
- EVALUATION OF TRANSITIONAL ZONE LESIONS ON MULTIPARAMETRIC MRI AND MRI-TARGETED BIOPSY IN DETECTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN THE COMMUNITY SETTING: A RETROSPECTIVE STUDY
- Creators
- Zachariah Taylor - Main Line HealthLaurence Belkoff - Main Line HealthCaroline Buckholtz - Philadelphia College of Osteopathic MedicineOliver Gibb - Drexel University
- Publication Details
- Urologic oncology, v 42, pp S101-S102
- Publisher
- Elsevier
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Surgery
- Other Identifier
- 991021916912404721