title: Multi-parametric magnetic resonance imaging to rule-in and rule-out clinically important prostate cancer in men at risk: a cohort study.
abstract: OBJECTIVE
  Overdiagnosis is arguably the greatest challenge in the management of men with prostate cancer. Multi-parametric (mp)-MRI prior to prostate biopsy may have a role in ruling-in and ruling-out clinically significant disease.
  
  
  METHODS
  114 consecutive men at risk of prostate cancer with previous biopsy underwent mp-MRI prior to transrectal ultrasound (TRUS)-guided biopsies. Standard systematic biopsies were carried out with targeting to suspicious areas.
  
  
  RESULTS
  59.6% had cancer detected by TRUS-guided biopsy. Mean age was 63.6 years (SD 9.0). If men had not been biopsied because of a negative mp-MRI, 21% (24/114) with no cancer and 5% (6/114) with clinically insignificant cancer could have avoided a biopsy. However, 4% (4/114) would have been advised to defer a biopsy that demonstrated the presence of clinically significant cancer.
  
  
  CONCLUSIONS
  mp-MRI may have a role in ruling-in and ruling-out clinically significant prostate cancer in men at risk prior to biopsy.
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Rouse
authors.forename: Greg
authors.initials: G
authors.lastname: Shaw
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.forename: Clare
authors.initials: C
authors.lastname: Allen
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D019564:Unnecessary Procedures
chemical_list: D017430:Prostate-Specific Antigen