title: Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature.
abstract: BACKGROUND
  Detection of clinically significant prostate cancer (PCa) is a major challenge. It has been shown that multiparametric magnetic resonance imaging (mpMRI) facilitates localisation of PCa and can help in targeting prostate biopsy.
  
  
  OBJECTIVE
  To systematically review the literature to determine the diagnostic accuracy of mpMRI in the detection of clinically significant PCa.
  
  
  METHODS
  The Pubmed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from January 1, 2000 to September 30, 2014, using the search criteria "prostate OR Pca OR PSA OR prostatic OR prostate cancer" AND "MR OR NMR OR NMRI OR MRI OR magnetic resonance OR ADC OR DWI OR DCE OR diffusion weighted OR dynamic contrast OR multiparametric OR MRSI OR MR spectroscopy". Two reviewers independently assessed 1729 records. Two independent reviewers assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) 2 tool.
  
  
  RESULTS
  Twelve articles were eventually selected. Patients had a median age of 62-65 yr (range 39-83 yr), a median prostate-specific antigen (PSA) level of 5.1-13.4 ng/ml (range 1.2-228 ng/ml), and Gleason score of 6-10. Various definitions of clinical significance were used, mainly based on maximum cancer core length and grade at biopsy, number of positive cores, and PSA. Detection of clinically significant PCa using mpMRI ranged from 44% to 87% in biopsy-naïve males and men with prior negative biopsies using prostate biopsy or definitive pathology of a radical prostatectomy specimen as the reference standard. The negative predictive value for exclusion of significant disease ranged from 63% to 98%.
  
  
  CONCLUSIONS
  mpMRI is able to detect significant PCa in biopsy-naïve males and men with prior negative biopsies. The negative predictive value of mpMRI is important to the clinician because mpMRI could be used to rule out significant disease. This may result in fewer or no systematic or targeted biopsies in patients with PSA suspicious for prostate cancer.
  
  
  RESULTS
  We reviewed the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (PCa). We conclude that mpMRI is able to detect significant PCa and may used to target prostate biopsies.
authors: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: jurgen.futterer@radboudumc.nl.
authors: Jurgen J
authors: JJ
authors: Fütterer
authors: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Alberto
authors: A
authors: Briganti
authors: Department of Radiology, Ghent University Hospital, Ghent, Belgium.
authors: Pieter
authors: P
authors: De Visschere
authors: Research Department of Urology, University College London, London, UK.
authors: Mark
authors: M
authors: Emberton
authors: Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy.
authors: Gianluca
authors: G
authors: Giannarini
authors: Department of Radiology, University College London Hospital, London, UK.
authors: Alex
authors: A
authors: Kirkham
authors: Division of Urologic Oncology, Department of Urology, NYU Langone Medical Center, New York, NY, USA.
authors: Samir S
authors: SS
authors: Taneja
authors: Department of Radiology, Neuroradiology and Nuclear Medicine, University of Bern, Inselspital, Bern, Switzerland.
authors: Harriet
authors: H
authors: Thoeny
authors: Department of Radiology, Ghent University Hospital, Ghent, Belgium.
authors: Geert
authors: G
authors: Villeirs
authors: Department of Urology, Lille University Medical Centre, University Lille Nord de France, Lille, France.
authors: Arnauld
authors: A
authors: Villers
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000175:diagnosis*
keywords: Multiparametric MRI; Prostate cancer; Systematic review