title: Utility of multiparametric magnetic resonance imaging suspicion levels for detecting prostate cancer.
abstract: OBJECTIVE
  We determine the usefulness of multiparametric magnetic resonance imaging in detecting prostate cancer, with a specific focus on detecting higher grade prostate cancer.
  
  
  METHODS
  Prospectively 583 patients who underwent multiparametric magnetic resonance imaging and subsequent prostate biopsy at a single institution were evaluated. On multiparametric magnetic resonance imaging, lesions were identified and scored as low, moderate or high suspicion for prostate cancer based on a validated scoring system. Magnetic resonance/ultrasound fusion guided biopsies of magnetic resonance imaging lesions in addition to systematic 12-core biopsies were performed. Correlations between the highest assigned multiparametric magnetic resonance imaging suspicion score and presence of cancer and biopsy Gleason score on the first fusion biopsy session were assessed using univariate and multivariate logistic regression models. Sensitivity, specificity, negative predictive value and positive predictive value were calculated and ROC curves were developed to assess the discriminative ability of multiparametric magnetic resonance imaging as a diagnostic tool for various biopsy Gleason score cohorts.
  
  
  RESULTS
  Significant correlations were found between age, prostate specific antigen, prostate volume, and multiparametric magnetic resonance imaging suspicion score and the presence of prostate cancer (p<0.0001). On multivariate analyses controlling for age, prostate specific antigen and prostate volume, increasing multiparametric magnetic resonance imaging suspicion was an independent prognosticator of prostate cancer detection (OR 2.2, p<0.0001). Also, incremental increases in multiparametric magnetic resonance imaging suspicion score demonstrated stronger associations with cancer detection in patients with Gleason 7 or greater (OR 3.3, p<0.001) and Gleason 8 or greater (OR 4.2, p<0.0001) prostate cancer. Assessing multiparametric magnetic resonance imaging as a diagnostic tool for all prostate cancer, biopsy Gleason score 7 or greater, and biopsy Gleason score 8 or greater separately via ROC analyses demonstrated increasing accuracy of multiparametric magnetic resonance imaging for higher grade disease (AUC 0.64, 0.69, and 0.72, respectively).
  
  
  CONCLUSIONS
  Multiparametric magnetic resonance imaging is a clinically useful modality to detect and characterize prostate cancer, particularly in men with higher grade disease.
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: M Minhaj
authors.initials: MM
authors.lastname: Siddiqui
authors.affiliation: Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Lambros
authors.initials: L
authors.lastname: Stamatakis
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Logan
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Hoang
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Annerleim
authors.initials: A
authors.lastname: Walton-Diaz
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Vourganti
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Hong
authors.initials: H
authors.lastname: Truong
authors.affiliation: Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland; Philips Research North America, Briarcliff Manor, New York.
authors.forename: Jochen
authors.initials: J
authors.lastname: Kruecker
authors.affiliation: Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.affiliation: Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.affiliation: Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland. Electronic address: pintop@mail.nih.gov.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen
keywords: DRE; MP-MRI; MR; MR/US; MRI; NPV; PCa; PPV; PSA; TRUS; bGS; biopsy; biopsy Gleason score; digital rectal examination; magnetic resonance; magnetic resonance imaging; magnetic resonance/ultrasound; multiparametric magnetic resonance imaging; negative predictive value; neoplasm grading; positive predictive value; prostate; prostate cancer; prostate specific antigen; transrectal ultrasound