Peripheral zone volume ratio (PZ-ratio) is relevant with biopsy results and can increase the accuracy of current diagnostic modality.

The current diagnostic modality of prostate cancer based on prostate specific antigen (PSA) and systematic biopsy is far from ideal in terms of over-diagnosing indolent prostate cancer and missing significant ones. Thus we integrated the peripheral zone volume ratio (PZ-ratio) for diagnostic refinement. This retrospective study included 247 consecutive patients who underwent initial transrectal ultrasound-guided systematic prostate biopsy from April 2014 to November 2015. Prostate volume was determined by semi-automatic contour on axial T2 weighted magnetic resonance imaging (MRI). PZ-ratio was inversely correlated with age (r = -0.36, p <0.0001). Adding PZ-ratio and MRI findings to the current predictive model (age, PSA density, percent-free PSA) significantly increased diagnostic accuracy in all patients (AUC: 0.871 vs. 0.812, p = 0.0059), but not in patient subgroup with PSA 4-10 ng/ml (AUC: 0.863 vs. 0.803, p = 0.12). The new model also significantly reduced the number of unnecessary biopsies while missing less significant cancers at a probability threshold of 25%. PZ-ratio is a potential tool in predicting biopsy results, and when added alone or in combination with MRI findings, the diagnostic accuracy can be further enhanced.