{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T03:52:44Z","timestamp":1788580364592,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the stratification differences of MRI and prostate\u2010specific antigen (PSA) density (PSAD) in the peripheral zone (PZ) and transition zone (TZ) lesions, in order to optimize the biopsy decision for patients with PSA 4\u201320\u2009ng\/mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analyzed 1524 patients undergoing MRI and biopsy. Lesions were grouped by PZ and TZ and the differences of PSAD within the subgroups were explored. A zonal\u2010specific risk matrix was constructed by integrating the Prostate Imaging Reporting and Data System (PI\u2010RADS) categories and PSAD in overall, PZ, and TZ cohorts. Low or high\u2010threshold pathway was constructed by 10% or 30% clinically significant prostate cancer (csPCa) probability for PZ and TZ. Six biopsy pathways were then formed and evaluated by the biopsy avoidance, csPCa detection, and positive predictive value (PPV). Finally, decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PZ lesions exhibited higher PSAD than TZ counterparts in equivalent PI\u2010RADS categories (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). In the risk matrix, for PI\u2010RADS 1\u20132 lesions, TZ required PSAD\u2009\u2265\u20090.15\u2009ng\/mL\/cm\n                      <jats:sup>3<\/jats:sup>\n                      while PZ\u2009\u2265\u20090.20\u2009ng\/mL\/cm\n                      <jats:sup>3<\/jats:sup>\n                      to achieve &gt;\u200910% csPCa risk. For PI\u2010RADS 3 lesions, thresholds were \u2265\u20090.15\u2009ng\/mL\/cm\n                      <jats:sup>3<\/jats:sup>\n                      (TZ) and \u2265\u20090.20\u2009ng\/mL\/cm\n                      <jats:sup>3<\/jats:sup>\n                      (PZ) to trigger biopsy at &gt;\u200930% csPCa risk. Among six pathways, the \u201cPZ high\u2009+\u2009TZ high\u201d pathway (PSAD\u2009\u2265\u20090.20\u2009ng\/mL\/cm\n                      <jats:sup>3<\/jats:sup>\n                      for PZ and \u2265\u20090.15\u2009ng\/mL\/cm\n                      <jats:sup>3<\/jats:sup>\n                      for TZ in PI\u2010RADS 3) achieved optimal balance, detecting 86.6% of csPCa while avoiding 48.0% of unnecessary biopsies, with a PPV of 69.1% (F1\u2010score\u2009=\u20090.77). DCA confirmed superior net clinical benefit for this pathway at \u2265\u200920% risk thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the risk stratification of MRI and PSAD, considering zonal specific of the lesion is helpful to improve biopsy decisions in patients with PSA 4\u201320\u2009ng\/mL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70075","type":"journal-article","created":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T12:59:15Z","timestamp":1759669155000},"page":"236-248","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Zonal\u2010Specific Risk Stratification Integrating Magnetic Resonance Imaging and Prostate\u2010Specific Antigen Density for Optimizing Prostate Biopsy Selection in Prostate\u2010Specific Antigen 4\u201320\u2009ng\/mL Patients"],"prefix":"10.1002","volume":"86","author":[{"given":"Liqin","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Radiology Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiology Pinghu Hospital of Traditional Chinese Medicine Pinghu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongsheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Radiology Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7241-901X","authenticated-orcid":false,"given":"Pengfei","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Radiology Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"issue":"6","key":"e_1_2_12_2_1","article-title":"PSA\u2010IgM and iXip in the Diagnosis and Management of Prostate Cancer: Clinical Relevance and Future Potential. A Review","volume":"92","author":"Maestroni U.","year":"2022","journal-title":"Acta Biomedica"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.05.068"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11934-019-0926-0"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20191050"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2023.10.006"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24840"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24886"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00016-X"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2022.10.002"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjr\/tqad027"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2019.08.015"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2446695"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2021204112"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.03.027"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15277"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2442067"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-023-03483-7"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)38491-4"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2025.111982"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24863"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/aja.aja_72_20"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-021-08216-6"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2011.06.012"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-26242-7"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1413953"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2019.02.033"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20210886"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-024-10700-z"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000001086"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.897130"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.2147\/RRU.S362070"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019182946"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-022-00549-y"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/0090-4295(94)90170-8"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-87311-1"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.22.27615"}],"container-title":["The Prostate"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T13:32:43Z","timestamp":1765805563000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pros.70075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,5]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/pros.70075"],"URL":"https:\/\/doi.org\/10.1002\/pros.70075","archive":["Portico"],"relation":{},"ISSN":["0270-4137","1097-0045"],"issn-type":[{"value":"0270-4137","type":"print"},{"value":"1097-0045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,5]]},"assertion":[{"value":"2025-04-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}