Assessing the value of mpmri pirads lesions in the transitional zone: analysis of a single center repeat biopsy cohort

INTRODUCTION AND OBJECTIVE: The aim of our study is to analyze the risk of prostate cancer in patients with transitional zone lesions on mpMRI METHODS: From 2016 to 2018, we consecutively enrolled 333 men undergoing transperineal repeat fusion biopsy in one single center in Italy. We collected demographic, clinical and histopathological data. Inclusion criteria include men with previous negative biopsies and MRI lesions located in the transitional zone of the prostate. The risk of prostate cancer and high-grade prostate cancer in patients with MRI lesions in the transitional zone was evaluated using chi-square and logistic regression analysis. High grade prostate cancer was defined as ISUP Grade Group 3 RESULTS: Overall 333 patients were enrolled, median age is 66(60/70) years, median PSA is 7.6(4.7/9.9) ng/ml and median prostate volume is 44(41/75) cc. 157/333 (47%) of the patients presented prostate cancer. Overall 319 lesions located in the transitional zone were analyzed: 3 PIRADS 1 (1%); 64 PIRADS 2 (20%), 147 PIRADS 3 (46%), 83 PIRADS 4 (26%) and 22 PIRADS 5 (7%). Patients with transitional zone PIRADS 3 lesions presented cancer in 9% of the cases and out of them only 2 (less than 1%) lesions presented high grade prostate cancer. Patients with with transitional zone PIRADS ?4 lesions presented cancer in 61% of the cases and out of them 27% presented high grade prostate cancer. CONCLUSIONS: According to our results PIRADS 3 lesions located in the transitional zone of the prostate have low risk of high-grade PCa (less than 1%), targeted biopsies on these lesions should be considered in selected patients. However, patients with transitional zone PIRADS ?4 lesions have a considerable risk of cancer and high-grade cancer and should therefore be investigated.