title: Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy.
abstract: OBJECTIVE
  This study aimed to prospectively analyze the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement magnetic resonance (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen levels (in the range of >or=4 ng/mL to <10 ng/mL) and prior negative random trans-rectal ultrasound (TRUS)-guided biopsy.
  
  
  METHODS
  This was a prospective randomized single-center study. One hundred and eighty eligible cases were included in the study. Patients in group A were submitted to a second random prostate biopsy, whereas patients in group B were submitted to a (1)H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy.
  
  
  RESULTS
  At the second biopsy, a prostate adenocarcinoma histologic diagnosis was found in 22 of 90 cases (24.4%) in group A and in 41 of 90 cases (45.5%) in group B (P = 0.01). On a patient-by-patient basis, MRSI had 92.3% sensitivity, 88.2% specificity, 85.7% positive predictive value (PPV), 93.7% negative predictive value (NPV), and 90% accuracy; DCEMR had 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV, and 83.3% accuracy; and the association MRSI plus DCEMR had 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV, and 90.7% accuracy, for predicting prostate cancer detection.
  
  
  CONCLUSIONS
  The combination of MRSI and DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. To avoid a potential bias, represented from having taken more samples in group B (mean of cores, 12.17) than in group A (10 cores), in the future a MRSI/DCEMR directed biopsy could be prospectively compared with a saturation biopsy procedure.
authors.affiliation: Department of Urology, University Sapienza, and Department of Urology, University of Rome, Rome, Italy. sciarra.md@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciarra
authors.forename: Valeria
authors.initials: V
authors.lastname: Panebianco
authors.forename: Mauro
authors.initials: M
authors.lastname: Ciccariello
authors.forename: Stefano
authors.initials: S
authors.lastname: Salciccia
authors.forename: Susanna
authors.initials: S
authors.lastname: Cattarino
authors.forename: Danilo
authors.initials: D
authors.lastname: Lisi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gentilucci
authors.forename: Andrea
authors.initials: A
authors.lastname: Alfarone
authors.forename: Silvia
authors.initials: S
authors.lastname: Bernardo
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gentile
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D003287:Contrast Media