Radiological criteria determining the detectability of prostate cancer in PIRADs 3 cases: Our multiparametric prostate mri results

Our study focuses on indeterminate lesions on prostate magnetic resonance imaging PIRADS 3 lesions. We aimed to evaluate PI-RADS 3 lesions using mpMRG findings, to aid the biopsy decision process. In our study, a total of 76 patients, who underwent both prostate magnetic resonance imaging and transrectal prostate biopsy, were retrospectively analyzed in Akdeniz University, Department of Radiology between 2015 and 2022. Two radiologists with 5 and 10 years experience interpretiert the patients'images. Signal intensity, size, border and morphological features, localization of lesions and prostate volume on T2W images; on the diffusion weight images, signal intensity and quantitşve ADC values were determined. The patients' age, PSA, free PSA values, and histopathological findings were obtained from the hospital archive system and recorded. In our study, 17 prostate cancers were detected in a total of 76 patients with PIRADS 3 lesions, and only 1 COAC was found. 15 of all prostate cancers were located in peripheral zone. On our study, it was found that the small prostat volume, low ADC values, and ill defined borders are independendet risk factors for malignancy among the PIRADS 3 lesions. Uncertainty at the lesion margin, low ADC values compared to 1180 μm2/sec, or prostate volume less than 50.5 cc were found to be risk factors for prostate cancer in PIRADS 3 cases. The combiniatons of risk factors will be helpful for decision to monitor such lesions. Our study showed the necessity of new risk classification systems together with other radiological and clinical parameters in the evaluation of PIRADS 3 cases. Biopsy of selected PIRADS 3 lesions with other markers should be considered, where the balance between the risk of missing clinically significant prostate cancer and unnecessarily biopsies and treatment procedures, that can be harmful. Multicentric studies with larger series are needed to determine additional parameters that may play a predictive role in the detection of COAC. Key words: PIRADS 3, prostate cancer, multiparametric prostate MRI, central-peripheral zone