title: The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy.
abstract: BACKGROUND
  Transrectal prostate biopsy has limited diagnostic accuracy. Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE) was a paired-cohort confirmatory study designed to assess diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in men requiring a repeat biopsy.
  
  
  METHODS
  All underwent 3 T mpMRI and transperineal template prostate mapping biopsies (TTPM biopsies). Multiparametric MRI was reported using Likert scores and radiologists were blinded to initial biopsies. Men were blinded to mpMRI results. Clinically significant prostate cancer was defined as Gleason ⩾4+3 and/or cancer core length ⩾6 mm.
  
  
  RESULTS
  Two hundred and forty-nine had both tests with mean (s.d.) age was 62 (7) years, median (IQR) PSA 6.8 ng ml (4.98-9.50), median (IQR) number of previous biopsies 1 (1-2) and mean (s.d.) gland size 37 ml (15.5). On TTPM biopsies, 103 (41%) had clinically significant prostate cancer. Two hundred and fourteen (86%) had a positive prostate mpMRI using Likert score ⩾3; sensitivity was 97.1% (95% confidence interval (CI): 92-99), specificity 21.9% (15.5-29.5), negative predictive value (NPV) 91.4% (76.9-98.1) and positive predictive value (PPV) 46.7% (35.2-47.8). One hundred and twenty-nine (51.8%) had a positive mpMRI using Likert score ⩾4; sensitivity was 80.6% (71.6-87.7), specificity 68.5% (60.3-75.9), NPV 83.3% (75.4-89.5) and PPV 64.3% (55.4-72.6).
  
  
  CONCLUSIONS
  In men advised to have a repeat prostate biopsy, prostate mpMRI could be used to safely avoid a repeat biopsy with high sensitivity for clinically significant cancers. However, such a strategy can miss some significant cancers and overdiagnose insignificant cancers depending on the mpMRI score threshold used to define which men should be biopsied.
authors.affiliation: Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, 21 University Street, London WC1E 7PN, UK.|Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Lucy A M
authors.initials: LAM
authors.lastname: Simmons
authors.affiliation: Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, 21 University Street, London WC1E 7PN, UK.|Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Abi
authors.initials: A
authors.lastname: Kanthabalan
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Manit
authors.initials: M
authors.lastname: Arya
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, London, UK.|Department of Urology, The Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, UK.
authors.forename: Dean
authors.initials: D
authors.lastname: Barratt
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Charman
authors.affiliation: Department of Pathology, UCLH NHS Foundation Trust London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Department of Urology, The Royal Free London NHS Foundation Trust, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Gelister
authors.affiliation: Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hawkes
authors.affiliation: Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, UK.
authors.forename: Yipeng
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Pathology, UCLH NHS Foundation Trust London, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Jameson
authors.affiliation: Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, 21 University Street, London WC1E 7PN, UK.|Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: McCartan
authors.affiliation: Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, 21 University Street, London WC1E 7PN, UK.|Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: Department of Radiology, UCLH NHS Foundation Trust, London, UK.|Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK.
authors.forename: Shonit
authors.initials: S
authors.lastname: Punwani
authors.affiliation: Department of Radiology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Navin
authors.initials: N
authors.lastname: Ramachandran
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
authors.affiliation: Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, 21 University Street, London WC1E 7PN, UK.|Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.affiliation: Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, 21 University Street, London WC1E 7PN, UK.|Department of Urology, UCLH NHS Foundation Trust, London, UK.|Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.|Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects / Q000379:methods*