The Role of Tumor Volume Ratio in Predicting Clinically Significant Prostate Cancer on Transperineal Biopsy

<b><i>Objectives:</i></b> Multiparametric magnetic resonance imaging (mpMRI) has made dramatic inroads into the management of localized prostate cancer (PCa); however, not all suspicious lesions represent clinically significant (cs) PCa. We aimed to analyze the hypothetical effect of incorporating tumor volume ratio (TVR) into prostate biopsy (PBx) decision-making. <b><i>Materials and Methods:</i></b> Two hundred and fifty-two patients with suspicious lesions at mpMRI undergoing transperineal PBx under local anesthesia between 2019 and 2022 were retrospectively evaluated. TVR was calculated by dividing the tumor volume by the prostate volume. A regression model was used to assess predictors of csPCa. Descriptive statistics were applied to evaluate the effect of including TVR in PBx decision-making. <b><i>Results:</i></b> Overall, 119 patients (47%) were found to have csPCa. Age (<i>p</i> < 0.001), prior negative PBx (<i>p</i> = 0.011), and TVR (<i>p</i> < 0.001) were found to be independent predictors of csPCa. Applying the TVR cutoff of 0.23, a total of 117/252 (46%) PBx would have been avoided at the cost of missing csPCa in 26 (10%) men. <b><i>Conclusions:</i></b> Age, previous biopsy status, and TVR were found to be independent predictors of csPCa in men with suspicious lesions at mpMRI. Implementation of TVR into PBx decision-making improves the accuracy of mpMRI. Future studies are required to validate our findings and evaluate the role of TVR in avoiding unnecessary PBx.