https://doi.org/10.4081/aiua.2026.15162
The relationship of prostate cancer diagnosed by magnetic resonance imaging/transrectal ultrasound prostate fusion biopsy with standard and adjusted anogenital distances
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Published: 26 June 2026
Aim: Several studies have reported contradictory associations between prostate cancer (PCa), tumor grade, and anogenital distances; however, all were based on conventional transrectal ultrasound (TRUS) prostate biopsy. We aimed to investigate the relationship between Anogenital distances (AGDs)/body mass index (BMI)-adjusted AGDs and overall PCa and clinically significant prostate cancer (csPCa) detected by multiparametric magnetic resonance imaging (MRI)/TRUS fusion prostate biopsy.
Materials and methods: All mp-MRI scans conducted from July 2020 to May 2024 for suspected PCa were reviewed for the study (n = 10,204). Among these, patients who underwent fusion biopsy due to Prostate Imaging-Reporting and Data System (PIRADS) 3/4/5 lesions were included in the study (n = 675). After exclusion criteria (n = 256), the remaining patients were divided into 3 groups. The study group (group-1, study group, n = 153 ) consisted of patients with cancer pathology, while the study subgroup (group-2, n = 80) included patients with csPCA. The control group (group-3, n = 266) comprised patients without cancer. The groups were comparatively analyzed with respect to demographic characteristics, clinical parameters, prostate-specific antigen (PSA)-related variables, mpMRI findings, biopsy characteristics, and pathological outcomes, AGDAnus to Penis (AGDAP), adjusted AGDAP, AGDAnus to scrotum (AGDAS), and adjusted AGDAS. Multivariable logistic regression analyses adjusted for age, prostate volume, PSA-related parameters, and PIRADS score were used to evaluate anogenital distance measures and identify independent predictors of csPCa.
Results: The study group exhibited a significantly higher age compared to the control group; nevertheless, no differences were seen between the groups for BMI and metabolic syndrome. As expected, there were significant differences between the study and control group in terms of total PSA, PSA density, DRE findings, and prostate volume. There was no significant difference between the study and control groups in terms of AGDAP, adjusted AGDAP, AGDAS, and adjusted AGDAS. When the csPCa subgroup was selected as the study group, no significant difference was observed between the control group in terms of AGDs and adjusted AGDs. Multivariable logistic regression analysis identified age and PIRADS score as independent predictors of csPCa, while prostate volume showed an inverse association. Although standard AGDAP demonstrated an independent association, other AGD parameters were not significant.
Conclusions: While standard AGDAP emerged as an independent predictor, BMI-adjusted AGD measures did not provide independent diagnostic value for csPCa in patients undergoing mpMRI/TRUS fusion biopsy
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Ethics Approval
CRediT authorship contribution
F.S.E. and A.E. made substantial contributions to the conception and design of the study; F.S.E. S.S and C.D. were responsible for data acquisition, including clinical data collection and anogenital distance measurements; R.T. contributed to the acquisition and interpretation of mpMRI data; F.S.E. A.E and S.S. performed the statistical analysis, interpreted the results and drafted the manuscript; A.E and R.T. critically revised the manuscript for important intellectual content; All authors contributed to the final approval of the manuscript and agree to be accountable for all aspects of the work.
Supporting Agencies
Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to institutional and patient privacy restrictions but are available from the corresponding author on reasonable request
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