Quantitative Evaluation of Apparent Diffusion Coefficient Values, ISUP Grades and Prostate-Specific Antigen Density Values of Potentially Malignant PI-RADS Lesions

SIMPLE SUMMARY: This study demonstrated a correlation between the apparent diffusion coefficient (ADC) of diffusion-weighted images and potentially malignant prostate lesions, with even better correlation when using the ratio of ADC and prostate-specific antigen density (PSAD), or ADC/PSAD, as a biomarker. Threshold values were determined in order to distinguish between histological cancer grades. Retrospectively, 403 patients with a total of 468 prostate lesions were enrolled. All patients had undergone multiparametric magnetic resonance imaging (mpMRI) and a subsequent biopsy of their prostate lesions, whereby their histological cancer grade was determined. Lower ADC values and lower ADC/PSAD ratios correlated with higher histological cancer stages. Therefore, it was possible to distinguish between histological cancer stages, and thus to reduce the number of unnecessary biopsies. ABSTRACT: The aim of this study was to demonstrate the correlation between ADC values and the ADC/PSAD ratio for potentially malignant prostate lesions classified into ISUP grades and to determine threshold values to differentiate benign lesions (noPCa), clinically insignificant (nsPCa) and clinically significant prostate cancer (csPCa). We enrolled a total of 403 patients with 468 prostate lesions, of which 46 patients with 50 lesions were excluded for different reasons. Therefore, 357 patients with a total of 418 prostate lesions remained for the final evaluation. For all lesions, ADC values were measured; they demonstrated a negative correlation with ISUP grades (p < 0.001), with a significant difference between csPCa and a combined group of nsPCa and noPCa (ns-noPCa, p < 0.001). The same was true for the ADC/PSAD ratio, but only the ADC/PSAD ratio proved to be a significant discriminator between nsPCa and noPCa (p = 0.0051). Using the calculated threshold values, up to 31.6% of biopsies could have been avoided. Furthermore, the ADC/PSAD ratio, with the ability to distinguish between nsPCa and noPCa, offers possible active surveillance without prior biopsy.