Prevalence of clinically significant prostate carcinoma in Prostate Imaging Reporting and Data System (PIRADS) 3 lesions detected in the peripheral zone on biparametric magnetic resonance imaging (MRI)—a local experience

The aim of this study was to determine whether biparametric magnetic resonance imaging (MRI) is effective in the diagnosis of clinically significant prostate cancer in prostate peripheral zone Prostate Imaging Reporting and Data System (PIRADS) 3 lesions without the use of dynamic contrast enhancement. Patients who underwent biparametric MRI over a 12-month period from January 2022 to December 2022 and were diagnosed with PIRADS 3 lesion in the peripheral zone were included in the study. No patient received dynamic contrast enhancement. Histological analysis was done after performing local anesthetic transperineal biopsy to determine detection rate of clinically significant prostate cancer. Prostate-specific antigen density (PSAD) and biopsy complication rates were also reviewed. Sixty-one out of 688 MRIs (8.8%) performed over the study period had a PIRADS 3 lesion in the peripheral zone where contrast is supposed to add value. Fifty-eight of the 61 went ahead to biopsy, and csPCa (Gleason score: ≥3 + 4, with a max core length of ≥6 mm and above) was diagnosed in 17%. Among those diagnosed with csPCa, 80% had a PSAD of >0.15 ng/ml/cc. No postbiopsy complications were reported. Biparametric MRI without contrast offers a reliable alternative to multiparametric MRI with minimum or neglible impact on clinically significant prostate cancer (csPCa) diagnosis in peripheral zone PIRADS 3 lesions, especially when used in conjunction with other factors such as PSAD. There is potential to address health economics and patient burden in prostate cancer investigation. •Magnetic resonance imaging (MRI) plays a pivotal investigative role in diagnosis of prostate cancer (PCa).•Non-contrast biparametric MRI shows promise in investigating Prostate Imaging Reporting and Data System (PIRADS) 3 lesions.•It has potential to reduce costs, exam time, and risks associated with contrast.