Glandular Density and Glandular Volume of the Peripheral Zone as Novel Pre-Biopsy Biometric Parameters: A Retrospective Pilot Study.

PURPOSE: Currently most patients with elevated PSA and suspicious MRI findings either have no cancer or clinically insignificant cancer on fusion biopsies, driving the need for developing risk to better stratify patients prior to biopsies. This retrospective pilot study demonstrates a novel approach of the glandular tissue volume within the peripheral zone (GVPZ) using pre-operative MRI measurements validated against radical prostatectomy specimens, as the majority of prostate cancer originates within the peripheral zone. PATIENTS AND METHODS: MRI and clinical parameters of 68 patients were analyzed retrospectively and associated with automated imaging processing data of H&E slides obtained from the corresponding radical prostatectomy specimens. RESULTS: The study results revealed a significant non-linear, inverse relationship between GVPZ and total prostate volume (TPV) (exp(b) = 0.963, SE = 0.008, p < 0.0001). GVPZ decreases as TPV rises, consistent with BPH-driven transition zone expansion progressively diluting glandular tissue content in the peripheral zone. Peripheral zone volume (PZV) was a significant positive predictor of GVPZ (exp(b) = 1.052, SE = 0.014, p < 0.0001). Differences in GDPZ and GVPZ were also observed across racial groups, though these findings are preliminary given the small subgroup sizes. CONCLUSION: Based on the presented data, total prostate volume is significantly and inversely associated with the glandular volume of the peripheral zone where most primary prostate cancer develops. These tissue-based anatomical markers represent candidate variables for incorporation into future risk calculators; prospective validation against biopsy-confirmed outcomes is required before clinical application.