title: Poor standard mp-MRI and routine biopsy fail to precisely predict intraprostatic tumor localization.
abstract: OBJECTIVE
  To evaluate the localization accuracy of routinely performed preoperative multiparametric MRI (mp-MRI), not being assessed according to PI-RADS criteria.
  
  
  METHODS
  One hundred and six patients underwent radical retropubic prostatectomy (January 2011-June 2012) with preoperative MRI. Intraprostatic tumor localization suggested by mp-MRI was correlated to both biopsy and histopathology results.
  
  
  RESULTS
  Sensitivity and specificity were as low as 25-62 and 60-94 %, respectively. Neither higher field force nor the use of an endorectal coil could enhance accuracy. There was no statistically significant concordance in any sextant. The mean number of correctly identified sextants was between 3.11 and 4.00 and, thus, insignificantly above the value of 3 that one would obtain by tossing the coin. For transrectal biopsies, sensitivity and specificity of tumor localization were 52-63 and 46-80 %, respectively.
  
  
  CONCLUSIONS
  Neither routinely performed "non-PI-RADS" MRI nor transrectal biopsy can accurately localize prostate cancer. Focal therapy concepts rely on a precise intraprostatic tumor detection and therefore inevitably require PI-RADS assessment by radiologists with genitourinary specialization. Regarding patient discomfort and costs, "non-PI-RADS" MRIs of the prostate are not justified.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany. andrea.billing@gmx.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Billing
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Localization accuracy; Multiparametric MRI; Prostate cancer; Radical retropubic prostatectomy; Transrectal biopsy