ArticleBMC medical imaging2026
A Feasibility study of a two-step ADC-PSAD-GWR rule for stratifying prostate lesions prior to biopsy.
Article in BMC medical imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo test the feasibility of a two-step rule integrating apparent diffusion coefficient (ADC), PSA density (PSAD), and gadolinium wash-in/wash-out rate (GWR) in stratifying prostate lesions for biopsy decision-making, and to compare its performance with PI-RADS v2.1 within a retrospective single-center cohort.
methodsThis retrospective case series included 110 patients (mean age 70 ± 9 years) who underwent 3.0-T mpMRI and prostate surgery. ADC, PSAD, and GWR were measured from index lesions. Optimal cutoffs (ADC 0.747 × 10⁻³ mm²/s, PSAD 0.344 ng/mL², GWR 9.454%) were derived by 5-fold cross-validation. A two-step rule was constructed: step 1 assigned lesions to four ADC-PSAD quadrants (Q1-Q4); step 2 refined risk using GWR. Performance was compared descriptively with PI-RADS.
resultsThe four-quadrant framework identified Q2 (low ADC/high PSAD) as the malignant-dominant quadrant and Q3 (high ADC/low PSAD) as predominantly benign. GWR refinement defined a subgroup (Q3 with low GWR) that contained no clinically significant prostate cancer (csPCa) among the 20 patients assigned. In the sensitivity analysis (all-grade PCa vs. benign), the same subgroup contained zero cancers. Compared with PI-RADS, the two-step rule avoided 35.1% (13/37) of unnecessary biopsies in PI-RADS ≥ 4 and detected all occult csPCa in PI-RADS ≤ 3 (12/12). Overall csPCa detection was 97.6% (41/42). Sensitivity analysis yielded consistent findings: unnecessary biopsy avoidance of 46.4% (13/28) and all-grade cancer detection of 98.0% (48/49).
conclusionThis feasibility study suggests that the two-step ADC-PSAD-GWR rule may help guide biopsy decisions by identifying a low-risk subgroup where biopsy may be safely deferred. However, due to the retrospective, single-center design and lack of external validation, the findings should be considered hypothesis-generating. No claim of superiority over PI-RADS or reduction in patient-important outcomes (e.g., mortality) is made.
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