title: The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer.
abstract: OBJECTIVE
  We assess the accuracy of multiparametric magnetic resonance imaging for significant prostate cancer detection before diagnostic biopsy in men with an abnormal prostate specific antigen/digital rectal examination.
  
  
  METHODS
  A total of 388 men underwent multiparametric magnetic resonance imaging, including T2-weighted, diffusion weighted and dynamic contrast enhanced imaging before biopsy. Two radiologists used PI-RADS to allocate a score of 1 to 5 for suspicion of significant prostate cancer (Gleason 7 with more than 5% grade 4). PI-RADS 3 to 5 was considered positive. Transperineal template guided mapping biopsy of 18 regions (median 30 cores) was performed with additional manually directed cores from magnetic resonance imaging positive regions. The anatomical location, size and grade of individual cancer areas in the biopsy regions (18) as the primary outcome and in prostatectomy specimens (117) as the secondary outcome were correlated to the magnetic resonance imaging positive regions.
  
  
  RESULTS
  Of the 388 men who were enrolled in the study 344 were analyzed. Multiparametric magnetic resonance imaging was positive in 77.0% of patients, 62.5% had prostate cancer and 41.6% had significant prostate cancer. The detection of significant prostate cancer by multiparametric magnetic resonance imaging had a sensitivity of 96%, specificity of 36%, negative predictive value of 92% and positive predictive value of 52%. Adding PI-RADS to the multivariate model, including prostate specific antigen, digital rectal examination, prostate volume and age, improved the AUC from 0.776 to 0.879 (p <0.001). Anatomical concordance analysis showed a low mismatch between the magnetic resonance imaging positive regions and biopsy positive regions (4 [2.9%]), and the significant prostate cancer area in the radical prostatectomy specimen (3 [3.3%]).
  
  
  CONCLUSIONS
  In men with an abnormal prostate specific antigen/digital rectal examination, multiparametric magnetic resonance imaging detected significant prostate cancer with an excellent negative predictive value and moderate positive predictive value. The use of multiparametric magnetic resonance imaging to diagnose significant prostate cancer may result in a substantial number of unnecessary biopsies while missing a minimum of significant prostate cancers.
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Thompson
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. Electronic address: p.vanleeuwen@garvan.org.au.
authors.forename: P J
authors.initials: PJ
authors.lastname: van Leeuwen
authors.affiliation: School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Moses
authors.affiliation: School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Shnier
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Brenner
authors.affiliation: University of Notre Dame, Darlinghurst, New South Wales, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Delprado
authors.affiliation: Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Pulbrook
authors.affiliation: Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Haynes
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Hayen
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: P D
authors.initials: PD
authors.lastname: Stricker
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies
keywords: biopsy; early detection of cancer; magnetic resonance imaging; prostate-specific antigen; prostatic neoplasms