Zonal origin combined with IVIM parameters could predict ISUP risk groups of prostate cancer

OBJECTIVES: To investigate the value of combining zonal origin with intravoxel incoherent motion (IVIM) parameters in predicting the International Society of Urological Pathology (ISUP) risk groups of prostate cancer. METHODS: The retrospective study enrolled 351 prostate cancer patients who underwent mpMRI including IVIM. Patients were stratified into low-risk and high-risk group according to ISUP grades, and divided into peripheral zone (PZ) and transition zone (TZ) cancer group according to zonal origins of lesions. Clinicopathological characteristics and IVIM-derived parameters between groups were compared. Logistic regression was performed to identify variables associated with ISUP high-risk group. The predictive accuracy of the variables for ISUP risk groups was evaluated using receiver operating characteristic (ROC) analysis. RESULTS: PZ cancers exhibited higher proportion of pathological stage ≥pT3 (P = .0184) and ISUP grade 3-5 (P < .0001), and demonstrated lower Dmean, ADCmin, and ADCmean (P = .0209, P = .0160, P = .0302) than TZ cancers. There was significant differences in zonal origin, Dmean, ADCmin, and ADCmean between the 2 ISUP risk groups (P < .0001, P < .0001, P = .0024, P = .0017). Zonal origin, prostate-specific antigen (PSA), Dmean, and ADCmin were identified as independent predictors of ISUP high-risk disease. The comprehensive model combining zonal origin, PSA, Dmean, and ADCmin demonstrated superior predictive performance (AUC = 0.956, 95% CI: 0.930-0.981) with a sensitivity of 90.63% and a specificity of 76.04%. CONCLUSIONS: The combined diagnostic model demonstrates high efficiency for predicting the ISUP risk group preoperatively for prostate cancer. ADVANCES IN KNOWLEDGE: The multiparameter predictive model including anatomical zones offers a non-invasive and effective tool for preoperative risk stratification for prostate cancer, thereby improving decision-making precision, and reducing unnecessary invasive procedures.