{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T19:03:28Z","timestamp":1789326208719,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intermediate\u2010risk prostate cancer (IR\u2010PCa) is a heterogeneous disease with variable clinical outcomes despite established risk classification. We evaluated whether pretreatment tumor apparent diffusion coefficient (ADC) derived from multiparametric MRI was associated with long\u2010term outcomes and provided additional prognostic information beyond established clinical risk classification in patients treated with definitive radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Materials<\/jats:title>\n                    <jats:p>We retrospectively analyzed 238 patients with IR\u2010PCa treated with definitive radiotherapy. Tumor ADC values were obtained from pre\u2010treatment diffusion\u2010weighted MRI. Patients were stratified according to ADC levels and clinical risk subgroups, including favorable and unfavorable intermediate\u2010risk disease. Survival analyses and Cox regression models were used to assess associations between ADC and clinical outcomes, including biochemical failure and distant metastasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At a median follow\u2010up of 10.3 years, 22 patients developed biochemical failure, and 12 developed distant metastases. Lower ADC values (\u2264\u20090.668\u2009\u00d7\u200910\n                      <jats:sup>\u22123\u2009<\/jats:sup>\n                      mm\n                      <jats:sup>2<\/jats:sup>\n                      \/s) were associated with inferior outcomes, with a significant impact on freedom from distant metastasis (FFDM) (HR 3.94, 95% CI 1.14\u201313.62;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). When ADC was combined with clinical risk classification, outcomes differed across the four resulting subgroups for both FFDM (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and FFBF (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). However, the FIR\u2013low ADC subgroup included only seven patients, and these subgroup findings should be considered exploratory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower tumor ADC was associated with an increased risk of distant metastasis and provided exploratory prognostic information beyond established clinical risk classification. Given the limited number of events and the data\u2010derived cutoff, these findings require external validation before ADC can be used to guide treatment selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70249","type":"journal-article","created":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T18:09:56Z","timestamp":1789322996000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of MRI\u2010Derived Apparent Diffusion Coefficient in Intermediate\u2010Risk Prostate Cancer Treated With Definitive Radiotherapy"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2742-9021","authenticated-orcid":false,"given":"Cem","family":"Onal","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center Baskent University Faculty of Medicine Adana Turkiye"},{"name":"Department of Radiation Oncology Baskent University Faculty of Medicine Ankara Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1706-8680","authenticated-orcid":false,"given":"Gurcan","family":"Erbay","sequence":"additional","affiliation":[{"name":"Department of Radiology, Adana Dr. Turgut Noyan Research and Treatment Center Baskent University Faculty of Medicine Adana Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3855-3391","authenticated-orcid":false,"given":"Aysenur","family":"Elmali","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Baskent University Faculty of Medicine Ankara Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3551-9000","authenticated-orcid":false,"given":"Birhan","family":"Demirhan","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology Iskenderun Gelisim Hospital  Hatay Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6908-3412","authenticated-orcid":false,"given":"Ozan Cem","family":"Guler","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center Baskent University Faculty of Medicine Adana Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2013.03.033"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2025.0052"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)65201-7"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2010.09570.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32401-1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.11091409"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.22395"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2008.08130.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.06.011"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2018.12.006"},{"issue":"7","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"4504","DOI":"10.1007\/s00330-023-10406-8","article-title":"Robustness of Apparent Diffusion Coefficient\u2010Based Lymph Node Classification for Diagnosis of Prostate Cancer Metastasis","volume":"34","author":"Noto B.","year":"2024","journal-title":"European Radiology"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-010-1999-9"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157313"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2023.0050"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20130617"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24888"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.04.029"},{"issue":"11","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.5489\/cuaj.3896","article-title":"Relationship Between Gleason Score and Apparent Diffusion Coefficients of Diffusion\u2010Weighted Magnetic Resonance Imaging in Prostate Cancer Patients","volume":"10","author":"Kim T. 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