title: How accurately can MRI detect indolent disease?
abstract: OBJECTIVE
  The current challenge in prostate cancer diagnosis is how to accurately measure the risk of disease progression and guide the treatment decision process between effective intervention for potentially harmful tumors and active surveillance for indolent disease. The issue is how to better identify patients harboring insignificant disease using the current diagnosis pathway based on 12-core systematic biopsy, which misclassifies tumor volume and/or grade in up to 30% of cases. Integrating MRI into the diagnosis process may help to better determine if the cancer is at very low risk of disease progression, i.e. clinically indolent or insignificant.
  
  
  RESULTS
  Recent advances in prostate imaging techniques suggest that multiparametric MRI has a high negative predictive value (up to 95%) in ruling out clinically significant prostate cancer and may potentially have clinical use in diagnostic pathways in men at risk for prostate cancer. Prospective studies should be performed to examine the rate of reclassification using MRI-targeted biopsy in patients potentially eligible for active surveillance based on current tests (12-cores systematics biopsies).
  
  
  CONCLUSIONS
  Patients with nonsuspicious multiparametric MRI represent a special very low-risk group of men with either no disease or clinically insignificant disease, allowing them to be managed conservatively.
authors.affiliation: aDepartment of Urology bDepartment of Radiology, CHU Lille, Univ Lille Nord de France, Lille cInserm U703, CHRU Lille, Univ Lille Nord de France, Loos, France.
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Philippe
authors.initials: P
authors.lastname: Puech
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
mesh_terms: D001706:Biopsy; D018450:Disease Progression; D055088:Early Detection of Cancer; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden; D057832:Watchful Waiting