# Prognostic features of biochemical recurrence of prostate cancer following radical prostatectomy based on diffusion kurtosis imaging

## TL;DR

This study identifies factors, including diffusion kurtosis imaging and histopathological features, that predict prostate cancer recurrence after surgery.

## Contribution

The study introduces the use of preoperative diffusion kurtosis imaging as a novel predictor for biochemical recurrence after radical prostatectomy.

## Key findings

- Baseline PSA, diffusion kurtosis imaging parameters, and histopathological features are associated with biochemical recurrence.
- Mean kurtosis values and ISUP grade group 4 or 5 are independent risk factors for recurrence.
- Combining imaging and clinical data improves risk stratification for recurrence.

## Abstract

To evaluate characteristics of diffusion kurtosis imaging (DKI), baseline prostate-specific antigen (PSA) and postoperative histopathological findings associated with biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP).

Totally, 44 BCR patients and 72 non-BCR patients who underwent RP from April 2019 to March 2021 were retrospective collected. Baseline PSA, parameters of DKI and histopathological characteristics of the patients were evaluated. Continuous variables were compared by independent sample t-test, and categorical variables were compared by Chi-square test and Fisher's exact test. Cox regression analysis was used to analyze the association between relevant characteristics and BCR. p<0.05 was considered statistically significant.

Results of univariate Cox regression analysis showed that baseline T-PSA (p<0.001), F-PSA (p=0.034), F/T-PSA (p<0.001), mean diffusivity (MD) (p=0.002), mean kurtosis (MK) (p<0.001) and apparent diffusion coefficient (ADC) (p=0.021) values, ISUP grade group 4 or 5 (p<0.001), positive extraprostatic extension (EPE) (p<0.001), positive perineural invasion (p=0.041), Positive surgical margin (p=0.001) and positive lymphovascular invasion (p<0.001) were correlated with BCR. However, results of multivariate Cox regression analysis showed that baseline T-PSA (HR=10.579; 95% CI, 4.405–27.670; p<0.001), MK value (HR=3.034; 95% CI, 1.809–5.089; p<0.001), ISUP grade group 4 or 5 (HR=3.121; 95% CI, 1.352–7.209; p=0.008), positive EPE (HR=2.219; 95% CI, 1.058–4.651; p=0.035) and positive surgical margin (HR=2.816; 95% CI, 1.585–4.845; p=0.025) were independent risk factors for BCR.

MK value, as well as baseline F-PSA, ISUP grade group 4 or 5, positive EPE and surgical margin were associated with BCR of PCa after RP.

The online version contains supplementary material available at 10.1186/s40644-026-00997-y.

The association between preoperative diffusion kurtosis imaging and biochemical recurrence of prostate cancer after radical prostatectomy is unknown.

Preoperative diffusion kurtosis imaging, as well as clinical and histopathological characteristics of prostate cancer, were significantly associated with biochemical recurrence.

Combining preoperative diffusion kurtosis imaging with baseline F-prostate-specific antigen and postoperative histopathological characteristics enables more precise risk stratification for biochemical recurrence after radical prostatectomy, thereby informing individualized surveillance planning and facilitating earlier detection of biochemical recurrence.

The online version contains supplementary material available at 10.1186/s40644-026-00997-y.