title: Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project.
abstract: OBJECTIVE
  To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT).
  
  
  METHODS
  An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results.
  
  
  RESULTS
  mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers.
  
  
  CONCLUSIONS
  The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community.
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, The Netherlands. m.j.scheltema@amc.uva.nl.
authors.forename: M J
authors.initials: MJ
authors.lastname: Scheltema
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Tay
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A W
authors.initials: AW
authors.lastname: Postema
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: D M
authors.initials: DM
authors.lastname: de Bruin
authors.affiliation: Desert Medical Imaging, Indian Wells, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Feller
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Futterer
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: George
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Gupta
authors.affiliation: Urologische Praxis Dr. Henkel and Dr. Kahmann, Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kahmann
authors.affiliation: CamPARI Prostate Cancer Clinic, Cambridge University Hospitals Trust, Cambridge, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kastner
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: Laguna
authors.affiliation: Department of Urology, Surgery and Bioengineering, University of California, Los Angeles, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Natarajan
authors.affiliation: Department of Urology and Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Rastinehad
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: de Reijke
authors.affiliation: Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Salomon
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Stone
authors.affiliation: Department of Urology, Institut Jules Bordet, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: van Velthoven
authors.affiliation: Department of Radiology, North Shore University Hospital, Northwell Health, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Villani
authors.affiliation: Department of Urology, Lille University Medical Center, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Villers
authors.affiliation: Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France.
authors.forename: J
authors.initials: J
authors.lastname: Walz
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Polascik
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J J M C H
authors.initials: JJMCH
authors.lastname: de la Rosette
mesh_terms: D055011:Ablation Techniques; D001706:Biopsy; D003452:Cryosurgery; D003697:Delphi Technique; D053672:Electrochemotherapy; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D053685:Laser Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D000072142:Pathologists; D010778:Photochemotherapy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D000072177:Radiologists; D011795:Surveys and Questionnaires; D000072178:Urologists
keywords: Consensus; Delphi; Focal therapy; Magnetic resonance imaging; Prostate cancer