Study Finds TD/PV Ratio Boosts Prostate Cancer Detection When Combined with PI-RADS

Published in Urologic Oncology: Seminars and Original Investigations, the study demonstrated that incorporating TD/PV into the biopsy process enhanced prediction accuracy, surpassing traditional markers. Additionally, when combined with the prostate imaging-reporting and data system (PI-RADS), TD/PV further improved prediction accuracy, achieving AUC values of 0.861 and 0.845 for PCa and csPCa, respectively.

MRI, alongside PI-RADS and MRI/TRUS fusion-targeted biopsy, has significantly improved the accuracy of prostate cancer diagnosis. However, some suspected PCa lesions in PI-RADS categories 3 and 4 remain undiagnosed, pointing to the need for further refinement of diagnostic methods. The researchers suggest that the accuracy of MRI/TRUS fusion-targeted biopsy can be improved by incorporating lesion size and prostate volume (PV) into the PI-RADS evaluation.

To explore this, Shunsuke Miyamoto and colleagues from the Department of Urology at Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan, investigated how the TD/PV ratio could enhance the prediction of PCa and csPCa in PI-RADS categories 3–5 lesions. They also aimed to develop predictive nomograms that combined TD/PV and PI-RADS.

The researchers reviewed data from patients who underwent MRI/TRUS fusion-targeted biopsy for PI-RADS 2.1 categories 3–5 lesions between 2017 and 2023. TD/PV was calculated by dividing tumor diameter by total prostate volume, with csPCa defined as a Gleason score of ≥ 3+4. The predictive nomograms for PCa and csPCa were created using univariable and multivariable logistic regression. Their accuracy was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC).

Key findings from the study included:

• A total of 565 patients were analyzed.
• The AUC of TD/PV was significantly higher than that of PSA, tumor diameter, PSA density, and PI-RADS for predicting PCa (AUC: 0.840) and csPCa (AUC: 0.819).
• Multivariable analyses confirmed TD/PV as a significant predictive factor for both PCa and csPCa in MRI/TRUS fusion-targeted biopsy.
• Predictive nomograms combining TD/PV and PI-RADS were developed, with AUCs for PCa and csPCa predictions being 0.861 and 0.845, respectively.

"In the retrospective analysis, the combination of TD/PV and PI-RADS category significantly improved the prediction of PCa and csPCa in MRI/TRUS fusion-targeted biopsy, particularly for PI-RADS categories 3 and 4 lesions," the authors noted. "The predictive nomograms integrating TD/PV with PI-RADS provided a more accurate prediction of PCa and csPCa diagnoses."

They concluded, "These findings offer valuable insights for physicians, aiding in better decision-making regarding the indications for MRI/TRUS fusion-targeted biopsy."

Reference:

Kohada, Y., Miyamoto, S., Hayashi, T., Tasaka, R., Honda, Y., Ishikawa, A., Kobatake, K., Sekino, Y., Kitano, H., Goto, K., Ikeda, K., Goriki, A., Hieda, K., Kitamura, N., Awai, K., & Hinata, N. (2025). Utility of tumor diameter-to-prostate volume ratio for predicting the outcome of magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy. Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2025.03.021