Objectives To analyze multiparametric MRI (mpMRI) characteristics of patients with International Society of Urological Pathology (ISUP) grade group (GG) 4 or 5 prostate cancer (PC) and to correlate MRI parameters with the occurrence of biochemical recurrence (BCR) after radical prostatectomy (RPE). Methods In this single-center cohort study consecutive patients with mpMRI and ISUP GG 4 or 5 PC were retrospectively analyzed. Clinical, MR-guided biopsy, and diagnostic mpMRI parameter were assessed. A subcohort of patients with RPE and follow-up was analyzed separately. A univariate and multivariate analyses were performed to determine parameters that are associated to patients with BCR after RPE. Results 145 patients (mean age 70y, median PSA 10.9 ng/ml) were analyzed. 99% had a PI-RADS classification of 4 or 5, 48% revealed MRI T3 stage, and median diameter of the MRI index lesion (IL) was 15 mm. IL showed a median ADC value of 668 ×10⁻⁶ mm²/s and exhibited contrast enhancement in 94% of the cases. For patients with follow-up after RPE (n = 82; mean follow-up time 68 ± 27 m), MRI parameters were significantly different for contact length of the IL to the pseudocapsule (LCC), MRI T3 stage, and IL localization (p < 0.05). Higher PSAD and MRI T3 stage were independent parameters for the risk of BCR when incorporating clinical, biopsy, and MRI parameters. Conclusion ISUP GG 4 or 5 PC has distinctive characteristics on mpMRI and were detected on MRI in all cases. In addition, higher PSAD and MRI T3 stage were significant predictors for BCR after RPE.

Cancer worry and risk perception are relevant psychological factors that influence preventive health behaviors. Therefore, a thorough understanding of the factors that impact their occurrence and manifestation is critical. The objective of this study was to assess prevalence and factors associated with worry about prostate cancer (PCa) and absolute/comparative risk perception in a community-based sample of 45-year-old men. Data were collected within the German PCa screening trial PROBASE. Variables were assessed by self-report questionnaires and a clinical interview. Worry about PCa and absolute/comparative risk perception were assessed each on a 5-point-Likert scale. Multivariable logistic regression was used to identify factors associated with the outcomes of interest. Data were available for 33,476 (72.0%) of 46,495 men at enrollment. 7.3% had sometimes/(very) often worry about PCa. 3.7% and 9.9% perceived their absolute risk and comparative risk as somewhat high/very high and somewhat higher/much higher, respectively. 18.8% reported a positive PCa family history. Important factors of worry about PCa, absolute risk perception, and comparative risk perception were lower urinary tract symptoms (LUTS) (OR 3.00, 95% CI 2.63–3.42; OR 2.09, CI 1.71–2.56; OR 2.41, CI 2.10–2.76) and a positive PCa family history (OR 2.35, CI 2.08–2.65; OR 15.13, CI 12.73–17.97; OR 9.69, CI 8.76–10.72). A positive history of urological (OR 3.85, CI 2.63–5.63) and non-urological cancers (OR 1.97, CI 1.52–2.54) were associated with a higher comparative risk perception. In conclusion, worry about PCa and risk perception are influenced by non-cancer-related symptoms as well as by a positive PCa family history. These findings need to be addressed in risk communication with patients.

To investigate the use of deep learning (DL) T2-weighted turbo spin echo (TSE) imaging sequence with deep learning acceleration (T2DL) in prostate MRI regarding the necessity of hyoscine butylbromide (HBB) administration for high image quality. One hundred twenty consecutive patients divided into four groups (30 for each group) were included in this study. All patients received a T2DL (version 2022/23) and a conventional T2 TSE (cT2) sequence on an implemented 3 T scanner and software system. Group A received cT2 with HBB compared to T2DL without HBB with a field of view (FOV) of 130 mm and group B with a FOV of 160 mm. Group C received both sequences with a FOV of 160 mm plus HBB and group D without HBB. Two radiologists independently evaluated all imaging datasets in a blinded reading regarding motion, sharpness, noise, and diagnostic confidence. Furthermore, we analyzed quantitative parameters by calculating edge rise distance (ERD), signal-to-noise-ratio (SNR), and contrast-to-noise-ratio (CNR). Friedman test was used for group comparisons. Baseline characteristics showed no significant differences between groups A-D. After HBB cT2 showed less motion artifacts, more sharpness, and a higher diagnostic confidence than T2DL, though DL sequences had significantly lower noise (p < 0.01). Quantitative analysis revealed higher SNR and CNR for T2DL sequences (p < 0.01), while edge rise distance (ERD) remained similar. Inter-reader agreement was good to excellent, with ICCs ranging from 0.84 to 0.93. T2DL acquisition time was significantly lower than for cT2. In our study, cT2 sequences with HBB showed superior image quality and diagnostic confidence while the T2DL sequence offer promising potential for reducing MRI acquisition times and performed better in quantitative measures like SNR and CNR. Additional studies are required to evaluate further adjusted and developed DL applications for prostate MRI on upcoming scanner generations and to assess tumor detection rates.