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Article ; Online: MRI-targeted prostate biopsy: a review of technique and results.

Robertson, Nicola L / Emberton, Mark / Moore, Caroline M

2013 Volume 10, Issue 10, Page(s) 589–597

Abstract: Multiparametric magnetic resonance imaging (mpMRI) is of interest for the diagnosis of clinically significant prostate cancer and mpMRI-targeted biopsies are being used increasingly in clinical practice. Target acquisition is performed using a range of ... ...

Abstract	Multiparametric magnetic resonance imaging (mpMRI) is of interest for the diagnosis of clinically significant prostate cancer and mpMRI-targeted biopsies are being used increasingly in clinical practice. Target acquisition is performed using a range of magnet strengths and varying combinations of anatomical and functional sequences. Target identification at the time of biopsy can be carried out in the MRI scanner (in-bore biopsy) or, more commonly, the MRI-target is biopsied under ultrasonographic guidance. Many groups use cognitive or visual registration, whereby the biopsy target is identified on MRI and ultrasonography is subsequently used to direct the needle to the same location. Other groups use registration software to show prebiopsy MRI data on real-time ultrasonography. The reporting of histological results in MRI-targeted biopsy studies varies greatly. The most useful reports compare the detection of clinically significant disease in standard cores versus mpMRI-targeted cores in the same cohort of men, as recommended by the STAndards of Reporting for MRI-Targeted biopsy studies (START) consensus panel. Further evidence is needed before an mpMRI-targeted strategy can be recommended as the standard intervention for men at risk of prostate cancer.
MeSH term(s)	Animals ; Biopsy ; Humans ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging/standards ; Male ; Prostate/metabolism ; Prostate/pathology ; Prostatic Neoplasms/diagnosis ; Prostatic Neoplasms/metabolism ; Ultrasound, High-Intensity Focused, Transrectal/methods ; Ultrasound, High-Intensity Focused, Transrectal/standards
Language	English
Publishing date	2013-09-24
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2493737-X
ISSN	1759-4820 ; 1759-4812
ISSN (online)	1759-4820
ISSN	1759-4812
DOI	10.1038/nrurol.2013.196
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Article ; Online: Extracapsular extension on MRI indicates a more aggressive cell cycle progression genotype of prostate cancer.

Wibmer, Andreas G / Robertson, Nicola L / Hricak, Hedvig / Zheng, Junting / Capanu, Marinela / Stone, Steven / Ehdaie, Behfar / Brawer, Michael K / Vargas, Hebert Alberto

Abdominal radiology (New York)

2019 Volume 44, Issue 8, Page(s) 2864–2873

Abstract: Purpose: To explore associations between magnetic resonance imaging (MRI) features of prostate cancer and expression levels of cell cycle genes, as assessed by the Prolaris: Materials and methods: Retrospective analysis of 118 PCa patients with ... ...

Abstract	Purpose: To explore associations between magnetic resonance imaging (MRI) features of prostate cancer and expression levels of cell cycle genes, as assessed by the Prolaris Materials and methods: Retrospective analysis of 118 PCa patients with genetic testing of biopsy specimen and prostate MRI from 08/2013 to 11/2015. Associations between the cell cycle risk (CCR) score and MRI features [i.e., PI-RADSv2 score, extracapsular extension (ECE), quantitative metrics] were analyzed with Fisher's exact test, nonparametric tests, and Spearman's correlation coefficient. In 41 patients (34.7%), test results were compared to unfavorable features on prostatectomy specimen (i.e., Gleason group ≥ 3, ECE, lymph node metastases). Results: Fifty-four (45.8%), 60 (50.8%), and 4 (3.4%) patients had low-, intermediate-, and high-risk cancers according to American Urological Association scoring system. Patients with ECE on MRI had significantly higher mean CCR scores (reader 1: 3.9 vs. 3.2, p = 0.015; reader 2: 3.6 vs. 3.2, p = 0.045). PI-RADSv2 scores and quantitative MRI features were not associated with CCR scores. In the prostatectomy subset, ECE on MRI (p = < 0.001-0.001) and CCR scores (p = 0.049) were significantly associated with unfavorable histopathologic features. Conclusion: The phenotypic trait of ECE on MRI indicates a more aggressive genotype of prostate cancer.
MeSH term(s)	Cell Cycle ; Disease Progression ; Extranodal Extension ; Genetic Testing ; Genotype ; Humans ; Image-Guided Biopsy ; Lymphatic Metastasis ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Prostatectomy ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/genetics ; Prostatic Neoplasms/surgery ; Retrospective Studies
Language	English
Publishing date	2019-04-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2839786-1
ISSN	2366-0058 ; 2366-004X
ISSN (online)	2366-0058
ISSN	2366-004X
DOI	10.1007/s00261-019-02023-1
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Article ; Online: Re: Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging: P. A. Pinto, P. H. Chung, A. R. Rastinehad, A. A. Baccala, Jr., J. Kruecker, C. J. Benjamin, S. Xu, P. Yan, S. Kadoury, C. Chua, J. K. Locklin, B. Turkbey, J. H. Shih, S. P. Gates, C. Buckner, G. Bratslavsky, W. M. Linehan, N. D. Glossop, P. L. Choyke and B. J. Wood J Urol 2011; 186: 1281-1285.

Robertson, Nicola L / Moore, Caroline M / Emberton, Mark

The Journal of urology

2012 Volume 187, Issue 4, Page(s) 1511–1512

MeSH term(s)	Biopsy, Needle ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Interventional ; Male ; Prostate/pathology ; Prostatic Neoplasms/diagnosis ; Ultrasonography, Interventional
Language	English
Publishing date	2012-02-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1016/j.juro.2011.12.007
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Article ; Online: Combined Whole Body and Multiparametric Prostate Magnetic Resonance Imaging as a 1-Step Approach to the Simultaneous Assessment of Local Recurrence and Metastatic Disease after Radical Prostatectomy.

Robertson, Nicola L / Sala, Evis / Benz, Matthias / Landa, Jonathan / Scardino, Peter / Scher, Howard I / Hricak, Hedvig / Vargas, Hebert A

The Journal of urology

2017 Volume 198, Issue 1, Page(s) 65–70

Abstract: Purpose: We report our initial experience with whole body and dedicated prostate magnetic resonance imaging as a single examination to assess local recurrence and metastatic disease in patients with suspected recurrent prostate cancer after radical ... ...

Abstract	Purpose: We report our initial experience with whole body and dedicated prostate magnetic resonance imaging as a single examination to assess local recurrence and metastatic disease in patients with suspected recurrent prostate cancer after radical prostatectomy. Materials and methods: In this institutional review board approved, retrospective, single center study 76 consecutive patients with clinically suspected recurrent prostate cancer following radical prostatectomy underwent combined whole body and dedicated prostate magnetic resonance imaging at a single session from October 2014 to January 2016. Scans were evaluated to detect disease in the prostate bed and regional nodes, and at distant sites. Comparison was made to other imaging tests, and prostate bed, node and bone biopsies performed within 90 days. Results: Whole body and dedicated prostate magnetic resonance imaging was completed successfully in all patients. Median prostate specific antigen was 0.36 ng/ml (range less than 0.05 to 56.12). Whole body and dedicated prostate magnetic resonance imaging identified suspected disease recurrence in 16 of 76 patients (21%), including local recurrence in the radical prostatectomy bed in 6, nodal metastases in 3, osseous metastases in 4 and multifocal metastatic disease in 3. In 43 patients at least 1 standard staging scan was done in addition to whole body and dedicated prostate magnetic resonance imaging. Concordance was demonstrated between the imaging modalities in 36 of 43 cases (84%). All metastatic lesions detected by other imaging tests were detected on magnetic resonance imaging. In addition, the magnetic resonance imaging modality detected osseous metastases in 4 patients with false-negative findings on other imaging tests, including 2 bone scans and 3 computerized tomography scans. It also excluded osseous disease in 1 patient with positive Conclusions: Combined whole body and dedicated prostate magnetic resonance imaging is feasible in a clinical practice setting. It can provide incremental information compared to standard imaging in men with suspected prostate cancer recurrence after radical prostatectomy.
MeSH term(s)	Aged ; Aged, 80 and over ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Multimodal Imaging ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/diagnostic imaging ; Prostate/diagnostic imaging ; Prostatectomy/methods ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery ; Retrospective Studies ; Whole Body Imaging
Language	English
Publishing date	2017-02-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1016/j.juro.2017.02.071
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Article ; Online: Prostate cancer risk inflation as a consequence of image-targeted biopsy of the prostate: a computer simulation study.

Robertson, Nicola L / Hu, Yipeng / Ahmed, Hashim U / Freeman, Alex / Barratt, Dean / Emberton, Mark

European urology

2013 Volume 65, Issue 3, Page(s) 628–634

Abstract: Background: Prostate biopsy parameters are commonly used to attribute cancer risk. A targeted approach to lesions found on imaging may have an impact on the risk attribution given to a man.: Objective: To evaluate whether, based on computer ... ...

Abstract	Background: Prostate biopsy parameters are commonly used to attribute cancer risk. A targeted approach to lesions found on imaging may have an impact on the risk attribution given to a man. Objective: To evaluate whether, based on computer simulation, targeting of lesions during biopsy results in reclassification of cancer risk when compared with transrectal ultrasound (TRUS) guided biopsy. Design, setting, and participants: A total of 107 reconstructed three-dimensional models of whole-mount radical prostatectomy specimens were used for computer simulations. Systematic 12-core TRUS biopsy was compared with transperineal targeted biopsies using between one and five cores. All biopsy strategies incorporated operator and needle deflection error. A target was defined as any lesion ≥ 0.2 ml. A false-positive magnetic resonance imaging identification rate of 34% was applied. Outcome measurements and statistical analysis: Sensitivity was calculated for the detection of all cancer and clinically significant disease. Cases were designated as high risk based on achieving ≥ 6 mm cancer length and/or ≥ 50% positive cores. Statistical significance (p values) was calculated using both a paired Kolmogorov-Smirnov test and the t test. Results and limitations: When applying a widely used biopsy criteria to designate risk, 12-core TRUS biopsy classified only 24% (20 of 85) of clinically significant cases as high risk, compared with 74% (63 of 85) of cases using 4 targeted cores. The targeted strategy reported a significantly higher proportion of positive cores (44% vs 11%; p<0.0001) and a significantly greater mean maximum cancer core length (7.8mm vs 4.3mm; p<0.0001) when compared with 12-core TRUS biopsy. Computer simulations may not reflect the sources of errors encountered in clinical practice. To mitigate this we incorporated all known major sources of error to maximise clinical relevance. Conclusions: Image-targeted biopsy results in an increase in risk attribution if traditional criteria, based on cancer core length and the proportion of positive cores, are applied. Targeted biopsy strategies will require new risk stratification models that account for the increased likelihood of sampling the tumour.
MeSH term(s)	Adult ; Aged ; Computer Simulation ; Humans ; Image-Guided Biopsy ; Male ; Middle Aged ; Prostate/pathology ; Prostatic Neoplasms/pathology ; Risk Assessment
Language	English
Publishing date	2013-01-03
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	193790-x
ISSN	1873-7560 ; 1421-993X ; 0302-2838
ISSN (online)	1873-7560 ; 1421-993X
ISSN	0302-2838
DOI	10.1016/j.eururo.2012.12.057
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Article ; Online: Extensive disease among potential candidates for hemi-ablative focal therapy for prostate cancer.

Takeda, Toshikazu / Tin, Amy L / Corradi, Renato B / Alvim, Ricardo / Hashimoto, Takeshi / Ito, Yujiro / Nguyen, Daniel P / Mamoor, Maha / Robertson, Nicola L / Vargas, Hebert A / Benfante, Nicole E / Sjoberg, Daniel D / Eastham, James A / Scardino, Peter T / Fine, Samson W / Oya, Mototsugu / Touijer, Karim A

International journal of urology : official journal of the Japanese Urological Association

2019 Volume 27, Issue 2, Page(s) 179–185

Abstract: Objective: To examine a set of proposed eligibility factors for hemi-ablative focal therapy in prostate cancer and to determine the likelihood of residual extensive disease.: Methods: We retrospectively analyzed data from 98 patients with unilateral ... ...

Abstract	Objective: To examine a set of proposed eligibility factors for hemi-ablative focal therapy in prostate cancer and to determine the likelihood of residual extensive disease. Methods: We retrospectively analyzed data from 98 patients with unilateral prostate cancer on biopsy with detailed tumor maps from whole-mount slides and preoperative magnetic resonance imaging data. These patients met the focal therapy consensus meeting inclusion criteria (prostate-specific antigen <15 ng/mL, clinical stage T1c-T2a and Gleason score 3 + 3 or 3 + 4 on needle biopsy), and underwent radical prostatectomy between 2000 and 2014. Extensive disease was defined as having Gleason pattern 4/5 in bilateral lobes, any extraprostatic extension, seminal vesicle invasion or lymph node invasion. Both lobes of the prostate were scored on magnetic resonance imaging. Preoperative characteristics including biopsy and magnetic resonance imaging data were used to predict extensive disease. Results: Among our cohort of 98 patients, 40% (95% CI 30-50%) had extensive disease. A total of 33% (95% CI 24-43%) had Gleason pattern 4/5 in both lobes with a median Gleason pattern 4/5 tumor volume in the biopsy negative lobe of 0.06 cm Conclusions: An important number of patients meeting the focal therapy consensus meeting inclusion criteria can present extensive disease. Further studies using targeted biopsies might provide more accurate information about the selection of focal therapy candidates.
MeSH term(s)	Humans ; Male ; Neoplasm Grading ; Neoplasm Staging ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery ; Retrospective Studies
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2019-12-13
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1328401-0
ISSN	1442-2042 ; 0919-8172
ISSN (online)	1442-2042
ISSN	0919-8172
DOI	10.1111/iju.14161
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Article ; Online: Prostate cancer detection using quantitative T

Giganti, Francesco / Gambarota, Giulio / Moore, Caroline M / Robertson, Nicola L / McCartan, Neil / Jameson, Charles / Bott, Simon R J / Winkler, Mathias / Whitcher, Brandon / Castro-Santamaria, Ramiro / Emberton, Mark / Allen, Clare / Kirkham, Alex

Journal of magnetic resonance imaging : JMRI

2017 Volume 47, Issue 6, Page(s) 1646–1653

Abstract: Background: T: Purpose/hypothesis: To investigate changes in quantitative T: Study type: Retrospective.: Population/subjects: Forty men randomized to 6 months of daily dutasteride (n = 20) or placebo (n = 20).: Field strength/sequence: ... ...

Abstract	Background: T Purpose/hypothesis: To investigate changes in quantitative T Study type: Retrospective. Population/subjects: Forty men randomized to 6 months of daily dutasteride (n = 20) or placebo (n = 20). Field strength/sequence: Multiparametric 3T MRI at baseline and 6 months. This included a multiecho MR sequence for quantification of the T Assessment: Two radiologists reviewed the scans in consensus according to Prostate Imaging Reporting and Data System (PI-RADS v. 2) guidelines. Statistical tests: Wilcoxon and Mann-Whitney U-tests, Spearman's correlation. Results: When compared to noncancerous tissue, shorter T Data conclusion: The exposure to antiandrogen therapy did not significantly influence the T Level of evidence: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1646-1653.
MeSH term(s)	5-alpha Reductase Inhibitors/therapeutic use ; Aged ; Androgen Antagonists/therapeutic use ; Biomarkers, Tumor ; Double-Blind Method ; Dutasteride/therapeutic use ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Retrospective Studies
Chemical Substances	5-alpha Reductase Inhibitors ; Androgen Antagonists ; Biomarkers, Tumor ; Dutasteride (O0J6XJN02I)
Language	English
Publishing date	2017-11-14
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Randomized Controlled Trial
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.25891
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Article ; Online: MRI findings in men on active surveillance for prostate cancer: does dutasteride make MRI visible lesions less conspicuous? Results from a placebo-controlled, randomised clinical trial.

Giganti, Francesco / Moore, Caroline M / Robertson, Nicola L / McCartan, Neil / Jameson, Charles / Bott, Simon R J / Winkler, Mathias / Gambarota, Giulio / Whitcher, Brandon / Castro, Ramiro / Emberton, Mark / Allen, Clare / Kirkham, Alex

European radiology

2017 Volume 27, Issue 11, Page(s) 4767–4774

Abstract: Objectives: To investigate changes in the Apparent Diffusion Coefficient (ADC) using diffusion-weighted imaging (DWI) in men on active surveillance for prostate cancer taking dutasteride 0.5 mg or placebo.: Methods: We analysed 37 men, randomised to ... ...

Abstract	Objectives: To investigate changes in the Apparent Diffusion Coefficient (ADC) using diffusion-weighted imaging (DWI) in men on active surveillance for prostate cancer taking dutasteride 0.5 mg or placebo. Methods: We analysed 37 men, randomised to 6 months of daily dutasteride (n = 18) or placebo (n = 19), undergoing 3T multi-parametric Magnetic Resonance Imaging (mpMRI) scans at baseline and 6 months. Images were reviewed blind to treatment allocation and clinical information. Mean ADC of peripheral (PZ) and transition (TZ) zones, and MR-suspicious lesions were compared between groups over 6 months. Conspicuity was defined as the PZ divided by tumour ADC, and its change over 6 months was assessed. Results: A decrease in mean conspicuity in the dutasteride group (but not the controls) was seen over 6 months (1.54 vs 1.38; p = 0.025). Absolute changes in ADC and conspicuity were significantly different between placebo and dutasteride groups at 6 months: (-0.03 vs 0.08, p = 0.033) and (0.11 vs -0.16, p = 0.012), as were percentage changes in the same parameters: (-2.27% vs 8.56% p = 0.048) and (9.25% vs -9.89% p = 0.013). Conclusions: Dutasteride was associated with increased tumour ADC and reduced conspicuity. A lower threshold for triggering biopsy might be considered in men on dutasteride undergoing mpMRI for prostate cancer. Key points: • Dutasteride increases ADC and reduces conspicuity in small mpMRI-visible prostate cancers. • Knowledge of dutasteride exposure is important in the interpretation of prostate mpMRI. • A lower threshold for triggering biopsy may be appropriate on dutasteride.
MeSH term(s)	5-alpha Reductase Inhibitors/therapeutic use ; Aged ; Biopsy ; Diffusion Magnetic Resonance Imaging ; Dutasteride/therapeutic use ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia/drug therapy ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology
Chemical Substances	5-alpha Reductase Inhibitors ; Dutasteride (O0J6XJN02I)
Language	English
Publishing date	2017-05-18
Publishing country	Germany
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-017-4858-0
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Article ; Online: Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation.

Nicolini, Daniele / Agostini, Andrea / Montalti, Roberto / Mocchegiani, Federico / Mincarelli, Cinzia / Mandolesi, Alessandra / Robertson, Nicola L / Candelari, Roberto / Giovagnoni, Andrea / Vivarelli, Marco

World journal of gastroenterology

2017 Volume 23, Issue 20, Page(s) 3690–3701

Abstract: Aim: To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).: Methods: We ... ...

Abstract	Aim: To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). Methods: We retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional ( Results: According to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, Conclusion: The radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.
Language	English
Publishing date	2017-05-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v23.i20.3690
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Article ; Online: Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review.

Moore, Caroline M / Robertson, Nicola L / Arsanious, Nasr / Middleton, Thomas / Villers, Arnauld / Klotz, Laurence / Taneja, Samir S / Emberton, Mark

European urology

2012 Volume 63, Issue 1, Page(s) 125–140

Abstract: Context: Technical improvements in prostate magnetic resonance imaging (MRI) have resulted in the use of MRI to target prostate biopsies.: Objective: To systematically review the literature to compare the accuracy of MRI-targeted biopsy with standard ...

Abstract	Context: Technical improvements in prostate magnetic resonance imaging (MRI) have resulted in the use of MRI to target prostate biopsies. Objective: To systematically review the literature to compare the accuracy of MRI-targeted biopsy with standard transrectal biopsy in the detection of clinically significant prostate cancer. Evidence acquisition: The PubMed, Embase, and Cochrane databases were searched from inception until December 3, 2011, using the search criteria 'prostate OR prostate cancer' AND 'magnetic resonance imaging OR MRI' AND 'biopsy OR target'. Four reviewers independently assessed 4222 records; 222 records required full review. Fifty unique records (corresponding to 16 discrete patient populations) directly compared an MRI-targeted with a standard transrectal approach. Evidence synthesis: Evidence synthesis was used to address specific questions. Where MRI was applied to all biopsy-naive men, 62% (374 of 599) had MRI abnormalities. When subjected to a targeted biopsy, 66% (248 of 374) had prostate cancer detected. Both targeted and standard biopsy detected clinically significant cancer in 43% (236 or 237 of 555, respectively). Missed clinically significant cancers occurred in 13 men using targeted biopsy and 12 using a standard approach. Targeted biopsy was more efficient. A third fewer men were biopsied overall. Those who had biopsy required a mean of 3.8 targeted cores compared with 12 standard cores. A targeted approach avoided the diagnosis of clinically insignificant cancer in 53 of 555 (10%) of the presenting population. Conclusions: MRI-guided biopsy detects clinically significant prostate cancer in an equivalent number of men versus standard biopsy. This is achieved using fewer biopsies in fewer men, with a reduction in the diagnosis of clinically insignificant cancer. Variability in study methodology limits the strength of recommendation that can be made. There is a need for a robust multicentre trial of targeted biopsies.
MeSH term(s)	Diagnostic Errors ; Digital Rectal Examination ; Humans ; Image-Guided Biopsy/methods ; Kallikreins/blood ; Magnetic Resonance Imaging ; Male ; Predictive Value of Tests ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/blood ; Prostatic Neoplasms/pathology ; Unnecessary Procedures
Chemical Substances	KLK3 protein, human (EC 3.4.21.-) ; Kallikreins (EC 3.4.21.-) ; Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2012-06-13
Publishing country	Switzerland
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	193790-x
ISSN	1873-7560 ; 1421-993X ; 0302-2838
ISSN (online)	1873-7560 ; 1421-993X
ISSN	0302-2838
DOI	10.1016/j.eururo.2012.06.004
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