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* Context.--Grade Group assessed using Gleason combined score and tumor extent is a main determinant for risk stratification and therapeutic planning of prostate cancer. Objective.--To develop a 3-dimensional magnetic resonance imaging (MRI) model regarding Grade Group and tumor extent in collaboration with uroradiologists and uropathologists for optimal treatment planning for prostate cancer. Design.--We studied the data from 83 patients with prostate cancer who underwent multiparametric MRI and subsequent MRI-transrectal ultrasound fusion biopsy and radical prostatectomy. A 3-dimensional MRI model was constructed by integrating topographic information of MRI-based segmented lesions, biopsy paths, and histopathologic information of biopsy specimens. The multiparametric MRI-integrated Grade Group and laterality were assessed by using the 3-dimensional MRI model and compared with the radical prostatectomy specimen. Results.--The MRI-defined index tumor was concordant with radical prostatectomy in 94.7% (72 of 76) of cases. The multiparametric MRI-integrated Grade Group revealed the highest agreement (weighted k, 0.545) and a significantly higher concordance rate (57.9%) than the targeted (47.8%, P =.008) and systematic (39.4%, P =.01) biopsies. The multiparametric MRI-integrated Grade Group showed significantly less downgrading rates than the combined biopsy (P =.001), without significant differences in upgrading rate (P =.06). The 3-dimensional multiparametric MRI model estimated tumor laterality in 66.2% (55 of 83) of cases, and contralateral clinically significant cancer was missed in 9.6% (8 of 83) of cases. The tumor length measured by multiparametric MRI best correlated with radical prostatectomy as compared with the biopsy-defined length. Conclusions.--The 3-dimensional model incorporating MRI and MRI-transrectal ultrasound fusion biopsy information easily recognized the spatial distribution of MRI-visible and MRI-nonvisible cancer and provided better Grade Group correlation with radical prostatectomy specimens but still requires validation. doi: 10.5858/arpa.2021-0256-OA, The integration of radiologic and pathologic information has been a demanding challenge in prostate cancer (PCa) as treatment options widened with active surveillance and focal therapy. (1,2) PCa could be [...]

Background: Deep learning‐based reconstruction (DLR) can potentially improve image quality by reduction of noise, thereby enabling fast acquisition of magnetic resonance imaging (MRI). However, a systematic evaluation of image quality and diagnostic performance of MRI using short acquisition time with DLR has rarely been investigated in men with prostate cancer. Purpose: To assess the image quality and diagnostic performance of MRI using short acquisition time with DLR for the evaluation of extraprostatic extension (EPE). Study Type: Retrospective. Population: One hundred and nine men. Field Strength/Sequence: 3 T; turbo spin echo T2‐weighted images (T2WI), echo‐planar diffusion‐weighted, and spoiled gradient echo dynamic contrast‐enhanced images. Assessment: To compare image quality, signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio (CNR) and subjective analysis using Likert scales on three T2WIs (MRI using conventional acquisition time, MRI using short acquisition time [fast MRI], and fast MRI with DLR) were performed. The diagnostic performance for EPE was evaluated by three independent readers. Statistical Tests: SNR, CNR, and image quality scores across the three imaging protocols were compared using Friedman tests. The diagnostic performance for EPE was assessed using the area under receiver operating characteristic curves (AUCs). P < 0.05 was considered statistically significant. Results: Fast MRI with DLR demonstrated significantly higher SNR (mean ± SD, 14.7 ± 6.8 vs. 8.8 ± 4.9) and CNR (mean ± SD, 6.5 ± 6.3 vs. 3.4 ± 3.6) values and higher image quality scores (median, 4.0 vs. 3.0 for three readers) than fast MRI. The AUCs for EPE were significantly higher with the use of DLR (0.86 vs. 0.75 for reader 2 and 0.82 vs. 0.73 for reader 3) compared with fast MRI, whereas differences were not significant for reader 1 (0.81 vs. 0.74; P = 0.09). Data Conclusion: DLR may be useful in reducing the acquisition time of prostate MRI without compromising image quality or diagnostic performance. Level of Evidence: 4 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

The relatively low specificity and positive predictive value of the Prostate Imaging‐Reporting and Data System (PI‐RADS) can lead to considerable false‐positive results and unnecessary biopsies. The aim of this study was to propose ancillary features (AFs) indicating clinically significant prostate cancer (csPCa) or benign tissues in PI‐RADS category ≥3 lesions and determine the usefulness of these AFs in reducing false‐positive assessments of suspicious lesions in men at csPCa risk. This was a retrospective study, which included 199 men. A 3T, including turbo spin echo T2‐weighted, echo‐planar diffusion‐weighted, and spoiled gradient echo dynamic contrast‐enhanced (DCE) images, was used. Five AFs (prostate‐specific antigen density ≥0.15 ng/mL2; size ≥10 mm; heterogeneous T2 signal intensity; circumscribed nodule in the junction of peripheral and transition zone; and DCE time curves) indicating csPCa or non‐csPCa were evaluated by three independent readers. The sensitivity and specificity of each AF were calculated. Inter‐reader agreement was evaluated using κ statistics. Univariate and multivariate logistic regression analyses were conducted to determine significant AFs. The reduction in positive call rates and csPCa detection rates with combined AF use were calculated and compared with the findings obtained with PI‐RADS use alone. The sensitivities and specificities of the AFs indicating csPCa were 72.1%–96.5% and 27.4%–75.2% for reader 1, 66.3%–96.5% and 23.9%–62.0% for reader 2, and 67.4%–96.5% and 34.5%–78.8% for reader 3, with moderate to substantial inter‐reader agreement (Fleiss κ, 0.551–0.643). The combined use of two or more AFs for assessing PI‐RADS ≥3 lesions resulted in a 19.6%–30.7% reduction in positive calls (p <.05) compared to PI‐RADS use alone while preserving the csPCa detection rates (p ≥.06) for three readers. The use of AFs in combination with PI‐RADS can reduce positive calls and false positives without csPCa under‐detection. [ABSTRACT FROM AUTHOR]