Location + ADC reduces biopsies by 62% for TZ PI-RADS 3 lesions

Combining anatomical location and ADC threshold for transition zone PI-RADS 3 lesions avoided 62% of biopsies while detecting 91% of clinically significant cancers, in a retrospective study of 218 lesions.

• Retrospective single-center study of 218 TZ PI-RADS 3 lesions in 128 patients with whole-mount histopathology after radical prostatectomy.
• Cancer detection rate was higher in location-risk positive (43% vs 4%, p<0.001) and ADC-risk positive (47% vs 10%, p<0.001) lesions; location-informed strategies showed higher net benefit than conventional biopsy.
• Limitations: retrospective design, single-center, virtual biopsy strategies not prospectively validated, and selection bias inherent to a surgical cohort.

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