The combination of prostate imaging reporting and data system version 2 (PI-RADS v2) and periprostatic fat thickness on multi-parametric MRI to predict the presence of prostate cancer

Abstract

PurposeTo evaluate the auxiliary effectiveness of periprostatic fat thickness (PPFT) on multi-parametric magnetic resonance imaging (mp-MRI) to Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) in predicting the presence of prostate cancer (PCa) and high-grade prostate cancer (HGPCa, Gleason Score ≥ 7).ResultsOverall, there were 371 patients (54.3%) with PCa and 292 patients (42.8%) with HGPCa. The mean value of PPFT was 4.04 mm. Multivariate analysis revealed that age, prostatic specific antigen (PSA), volume, PI-RADS score, and PPFT were independent predictors of PCa. All factors plus abnormal digital rectal exam were independent predictors of HGPCa. In addition, the PPFT was the independent predictor of PCa (Odds ratio [OR] 2.56, p = 0.004) and HGPCa (OR 2.70, p = 0.014) for subjects with PI-RADS grade 3. The present two nomograms based on multivariate analysis outperformed the single PI-RADS in aspects of predicting accuracy for PCa (area under the curve: 0.922 vs. 0.883, p = 0.029) and HGPCa (0.919 vs. 0.873, p = 0.007). Decision-curve analysis also indicated the favorable clinical utility of the present two nomograms.Materials and MethodsThe clinical data of 683 patients who received transrectal ultrasound guided biopsy and prior mp-MRI were reviewed. PPFT was measured as the shortest perpendicular distance from the pubic symphysis to the prostate on MRI. Univariate and multivariate analyses were performed to determine the independent predictors of PCa and HGPCa. We also constructed two nomograms for predicting PCa and HGPCa based on the logistic regression.ConclusionThe PPFT on mp-MRI is an independent predictor of PCa and HGPCa, notably for patients with PI-RADS grade 3. The nomograms incorporated predictors of PPFT and PI-RADS demonstrated good predictive performance.

Mechanistic Insights into the Link between Obesity and Prostate Cancer

“…van Roermund et al found a significant association between periprostatic fat density measured on computed tomography (CT) and having a high-risk of prostate cancer [ 29 ]. This finding has been corroborated by multiple other studies that used magnetic resonance imaging to measure the periprostatic adipose tissue thickness [ 30 , 31 , 32 ]. There is evidence of higher level of inflammatory cytokines within the periprostatic adipose tissue.…”

Peri‐prostatic adipose tissue: the metabolic microenvironment of prostate cancer

“…In their study, there were significant associations between PPAT area and both clinical stage and Gleason score, but not for BMI. Recently, two clinical studies have also shown that PPAT measured by MRI is an independent predictor for aggressive PCa .…”

Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia progression

“…The relationships between PPF and both tumorigenesis and tumor progression in PCa have recently gained traction due to their potential role in the tumor microenvironment. 10 11 12 13 However, little is known on the potential utility of PPF as a predictor of clinical progression in patients with BPH.…”

“…Several clinical studies have shown that PPF thickness (PPFT) correlates with the tumorigenesis and tumor progression of PCa. 8 10 11 12 13 Cao et al . 12 demonstrated that PPFT measured on magnetic resonance imaging (MRI) was an independent predictor of the development of PCa and high-grade PCa.…”