title: Detection and localization of prostate cancer with the targeted biopsy strategy based on ADC map: a prospective large-scale cohort study.
abstract: OBJECTIVE
  To investigate the usefulness of targeted biopsy strategy based on apparent diffusion coefficient (ADC) maps in the detection and localization of prostate cancer.
  
  
  METHODS
  Institutional review board approval and informed consent from all participants were obtained. This study included 1448 consecutive patients suspected of having prostate cancer based on PSA level, who were divided into two groups: Group A included 890 patients with low-ADC lesions who underwent targeted and systematic biopsies; Group B included 558 patients with no low-ADC lesions who underwent only systematic biopsies. The cancer detection rates (CDR) of each group, positive predictive value (PPV), and negative predictive value (NPV) of ADC maps were calculated.
  
  
  RESULTS
  The CDR was 70.1% for Group A, higher than those for overall patients (48.1%) and for Group B (13.1%) with significant difference (P < 0.001). In the serum, PSA range from 4 to 20 ng/mL, the CDR was higher for the Group A than for the Group B and overall patients with significant differences. PPV and NPV of MR findings were 70.1% and 86.9%, respectively. Especially, the PPV of the MR findings for the anterior portion was as high as 90.1%. Among the false negatives of MR findings, Gleason score proved 6 or smaller in 79.5%, and positive core number was merely one or two in 80.8%.
  
  
  CONCLUSIONS
  The targeted biopsy strategy based on ADC maps can be useful in the detection and localization of prostate cancer with high PPV.
authors.affiliation: Department of Radiology, Kurashiki Central Hospital, Kurashiki, Japan. yw5904@kchnet.or.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Tohru
authors.initials: T
authors.lastname: Araki
authors.forename: Masako
authors.initials: M
authors.lastname: Nagayama
authors.forename: Akira
authors.initials: A
authors.lastname: Okumura
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Amoh
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ishimori
authors.forename: Mana
authors.initials: M
authors.lastname: Ishibashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Nakashita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Dodo
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007564:Japan / Q000453:epidemiology; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity