{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:58:58Z","timestamp":1789585138447,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: To investigate the importance of ADC, SUVmax, and SUVmax\/ADC values in the prognosis and biological behavior of prostate cancer. Methods: In this retrospective study, ADC measurements in diffusion MRI were made by two radiologists by correlating the lesions with the highest SUVmax value from Ga-68 PSMA PET\/CT examinations of 81 patients with prostate cancer. The quantitative values were compared with histopathological grade, presence of perineural invasion, and lymph node and bone metastasis. Results: For D\u2019Amico high-risk patients, a statistically significant difference among the ADC, SUVmax, and SUVmax\/ADC measurements was reported (p &lt; 0.001). Cut-off values were defined as 0.52 (\u00d710\u22123 mm2\/s) for ADC, 9.73 for SUVmax, and 20.28 for the SUVmax\/ADC ratio (AUC = 0.887, 0.747, 0.817, respectively) for the high-risk categories. The Youden indices were 0.643, 0.405, and 0.437, respectively. In logistic regression, the SUVmax\/ADC ratio was a significant predictor of the high-risk group (AUC = 0.844, p = 0.002), demonstrating superior performance to a model with individual ADC and SUVmax values (AUC = 0.796, p = 0.006). For the advanced-grade group, the SUVmax and SUVmax\/ADC ratios differed significantly (p &lt; 0.001). The CAPRA score showed significant correlations with all imaging biomarkers: negatively with ADC (rho = \u22120.456, p &lt; 0.001) and positively with SUVmax (rho = 0.359, p = 0.001) and the SUVmax\/ADC ratio (rho = 0.441, p &lt; 0.001). The presence of perineural invasion had no significant correlation with any of the variables (p &gt; 0.05). The presence of bone metastases and PSA and free PSA levels differed significantly (p = 0.003, p = 0.001, respectively). In the presence of lymph node metastasis, SUVmax and SUVmax\/ADC ratios were found to be significant (p = 0.019, p = 0.01, respectively). In the survival (OS) analysis, a low ADC value was found to be associated with shorter survival (median OS: 61 vs. 106 months). Conclusions: Among advanced-grade and high-risk prostate cancer patients, ADC, SUVmax, and SUVmax\/ADC values can be employed as alternative prognostic factors for predicting the biological behavior of the disease.<\/jats:p>","DOI":"10.3390\/jcm14207150","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:47:08Z","timestamp":1760104028000},"page":"7150","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictive Value of Quantitative ADC, SUVmax, and the SUVmax\/ADC Ratio for Biological Behavior and Prognosis in High-Risk Prostate Cancer"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6623-3024","authenticated-orcid":false,"given":"Abdullah Enes","family":"Ata\u015f","sequence":"first","affiliation":[{"name":"Department of Radiology, Necmettin Erbakan University, Konya 42090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dclk\u00fc","family":"Kerimo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Necmettin Erbakan University, Konya 42090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6458-2316","authenticated-orcid":false,"given":"Zeki","family":"\u0130lhan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sana Klinikum Hof, 95032 Hof, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4788-4734","authenticated-orcid":false,"given":"\u015eeyma","family":"\u00dcn\u00fcvar","sequence":"additional","affiliation":[{"name":"Department of Radiology, Konya City Hospital, Konya 42020, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Necmettin Erbakan University, Konya 42090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1188-6612","authenticated-orcid":false,"given":"Zeynep","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Konya City Hospital, Konya 42020, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hac\u0131 Hasan","family":"Esen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Necmettin Erbakan University, Konya 42090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"443","DOI":"10.3109\/21681805.2013.776106","article-title":"Perineural Invasion as a Predictor of Extraprostatic Extension of Prostate Cancer: A Systematic Review and Meta-Analysis","volume":"47","author":"Cozzi","year":"2013","journal-title":"Scand. 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