Pharmacokinetic modeling of dynamic contrast-enhanced (DCE)-MRI in PI-RADS category 3 peripheral zone lesions: preliminary study evaluating DCE-MRI as an imaging biomarker for detection of clinically significant prostate cancers

Purpose To determine if pharmacokinetic modeling of DCE-MRI can diagnose CS-PCa in PI-RADS category 3 PZ lesions with subjective negative DCE-MRI. Materials and methods In the present IRB approved, bi-institutional, retrospective, case–control study, we identified 73 men with 73 PZ PI-RADS version 2.1 category 3 lesions with MRI-directed-TRUS-guided targeted biopsy yielding: 12 PZ CS-PCa (ISUP Grade Group 2; N = 9, ISUP 3; N = 3), 27 ISUP 1 PCa and 34 benign lesions. An expert blinded radiologist segmented lesions on ADC and DCE images; segmentations were overlayed onto pharmacokinetic DCE-MRI maps. Mean values were compared between groups using univariate analysis. Diagnostic accuracy was assessed by ROC. Results There were no differences in age, PSA, PSAD or clinical stage between groups ( p = 0.265–0.645). Mean and 10th percentile ADC did not differ comparing CS-PCa to ISUP 1 PCa and benign lesions ( p = 0.376 and 0.598) but was lower comparing ISUP ≥ 1 PCa to benign lesions ( p 0.05). AUC for diagnosis of CS-PCa using Ktrans and Ve were: 0.69 (95% CI 0.52–0.87) and 0.69 (0.49–0.88). Conclusion Pharmacokinetic modeling of DCE-MRI parameters in PI-RADS category 3 lesions with subjectively negative DCE-MRI show significant differences comparing CS-PCa to ISUP 1 PCa and benign lesions, in this study outperforming ADC. Studies are required to further evaluate these parameters to determine which patients should undergo targeted biopsy for PI-RADS 3 lesions.