***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: R and om systematic ultrasound guided transrectal core biopsies of the prostate were compared to directed biopsies of specific hypoechoic defects in 136 men with abnormal prostates on digital rectal examination . Prostate cancer was diagnosed in 83 of 136 patients ( 62 per cent ) . In 80 of 83 individuals ( 94 per cent ) the cancer was detected by r and om systematic biopsies alone . Of 57 men in whom r and om systematic and directed biopsies were obtained the results of biopsy agreed in 86 per cent , while in 9 per cent r and om systematic biopsies found cancers missed by directed biopsies and in 5 per cent directed biopsies diagnosed cancers missed by r and om systematic prostate biopsies . Ultrasound guided r and om systematic biopsy is simple and easily learned . When combined with additional directed biopsies of the rare hypoechoic areas not included in the pattern of systematic sampling , it provides a highly accurate means to diagnose prostate cancer , minimizing observer and sampling errors . This technique of prostate mapping with 6 , 1.5 cm . cores provides valuable additional information on cancer volume , Gleason grade and the potential location of surgically positive margins , all without compromising the operation or the chance for a surgical cure BACKGROUND Increasing evidence supports the use of magnetic resonance (MR)-targeted prostate biopsy . The optimal method for such biopsy remains undefined , however . OBJECTIVE To prospect ively compare targeted biopsy outcomes between MR imaging (MRI)-ultrasound fusion and visual targeting . DESIGN , SETTING , AND PARTICIPANTS From June 2012 to March 2013 , prospect i ve targeted biopsy was performed in 125 consecutive men with suspicious regions identified on prebiopsy 3-T MRI consisting of T2-weighted , diffusion-weighted , and dynamic-contrast enhanced sequences . INTERVENTION Two MRI-ultrasound fusion targeted cores per target were performed by one operator using the ei-Nav|Artemis system . Targets were then blinded , and a second operator took two visually targeted cores and a 12-core biopsy . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Biopsy information yield was compared between targeting techniques and to 12-core biopsy . Results were analyzed using the McNemar test . Multivariate analysis was performed using binomial logistic regression . RESULTS AND LIMITATIONS Among 172 targets , fusion biopsy detected 55 ( 32.0 % ) cancers and 35 ( 20.3 % ) Gleason sum ≥7 cancers compared with 46 ( 26.7 % ) and 26 ( 15.1 % ) , respectively , using visual targeting ( p=0.1374 , p=0.0523 ) . Fusion biopsy provided informative nonbenign histology in 77 targets compared with 60 by visual ( p=0.0104 ) . Targeted biopsy detected 75.0 % of all clinical ly significant cancers and 86.4 % of Gleason sum ≥7 cancers detected on st and ard biopsy . On multivariate analysis , fusion performed best among smaller targets . The study is limited by lack of comparison with whole-gl and specimens and sample size . Furthermore , cancer detection on visual targeting is likely higher than in community setting s , where experience with this technique may be limited . CONCLUSIONS Fusion biopsy was more often histologically informative than visual targeting but did not increase cancer detection . A trend toward increased detection  with fusion biopsy was observed across all study subsets , suggesting a need for a larger study size . Fusion targeting  improved accuracy for smaller lesions . Its use may reduce the learning curve necessary for visual targeting and improve community adoption of MR-targeted biopsy BACKGROUND Gleason scores from st and ard , 12-core prostate biopsies are up grade d historically in 25 - 33 % of patients . Multiparametric prostate magnetic resonance imaging ( MP-MRI ) with ultrasound (US)-targeted fusion biopsy may better sample the true gl and pathology . OBJECTIVE The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a st and ard 12-core biopsy regimen alone . DESIGN , SETTING , AND PARTICIPANTS There were 582 subjects enrolled from August 2007 through August 2012 in a prospect i ve trial comparing systematic , extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The highest Gleason score from each biopsy method was compared . INTERVENTIONS An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies . RESULTS AND LIMITATIONS A diagnosis of prostate cancer ( PCa ) was made in 315 ( 54 % ) of the patients . Addition of targeted biopsy led to Gleason upgrading in 81 ( 32 % ) cases . Targeted biopsy detected 67 % more Gleason ≥4 + 3 tumors than 12-core biopsy alone and missed 36 % of Gleason ≤3 + 4 tumors , thus mitigating the detection of lower- grade disease . Conversely , 12-core biopsy led to upgrading in 67 ( 26 % ) cases over targeted biopsy alone but only detected 8 % more Gleason ≥4 + 3 tumors . On multivariate analysis , MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions ( p<0.001 ) . The main limitation of this study was that definitive pathology from radical prostatectomy was not available . CONCLUSIONS MRI/US-fusion-guided biopsy up grade s and detects PCa of higher Gleason score in 32 % of patients compared with traditional 12-core biopsy alone . Targeted biopsy technique preferentially detects higher- grade PCa while missing lower- grade tumors Objective : To assess the use of diffusion-weighted imaging ( DWI ) at 3 Tesla ( T ) for lesion localization in patients with a high risk of prostate cancer before a rebiopsy . Material s and Methods : A total of 43 patients ( age range , 40–80 years ; mean age , 62.6 years ) who had previously undergone a transrectal ultrasound (TRUS)-guided biopsy that was negative and continued to have a persistent elevated prostate specific antigen level underwent DWI with b = 0 s/mm2 and b = 1000 s/mm2 before a rebiopsy . We located the area of the lowest apparent diffusion coefficient values and performed a target biopsy of that area , followed by a systematic biopsy under TRUS guidance . We evaluated the cancer detection rate , tumor location , and lesion visibility on T2-weighted imaging  ( T2WI ) in patients with biopsy-proven cancers . Results : Prostate cancer was detected in 17 ( 39.5 % ) patients , and was more predominant in the transitional zone ( 76.4 % , 13/17 ) than in the peripheral zone ( 23.6 % , 4/17 ) ( P < 0.05 ) . Of the 17 cancers detected on DWI , 6 lesions were seen on T2WI . Conclusion : DWI in addition to T2WI at 3 T has the potential to provide important information on lesion localization in patients that had both previous negative TRUS biopsy and persistently elevated prostate specific antigen levels before a repeated biopsy PURPOSE Given the limitations of prostate specific antigen and st and ard biopsies for detecting prostate cancer , we evaluated the cancer detection rate and external validity of a magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy system used at the National Institutes of Health . MATERIAL S AND METHODS We performed a phase III trial of a magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy system with participants enrolled between 2012 and 2013 . A total of 153 men consented to the study and underwent 3 Tesla multiparametric magnetic resonance imaging with an endorectal coil for clinical suspicion of prostate cancer . Lesions were classified as low or moderate/high risk for prostate cancer . Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy and st and ard 12-core prostate biopsy were performed and 105 men were eligible for analysis . RESULTS Mean patient age was 65.8 years and mean prostate specific antigen was 9.5 ng/ml . The overall cancer detection rate was 62.9 % ( 66 of 105 patients ) . The cancer detection rate in those with moderate/high risk on imaging was 72.3 % ( 47 of 65 ) vs 47.5 % ( 19 of 40 ) in those classified as low risk for prostate cancer ( p<0.05 ) . Mean tumor core length was 4.6 and 3.7 mm for fusion biopsy and st and ard 12-core biopsy , respectively ( p<0.05 ) . Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy detected prostate cancer that was missed by st and ard 12-core biopsy in 14.3 % of cases ( 15 of 105 ) , of which 86.7 % ( 13 of 15 ) were clinical ly significant . This biopsy up grade d 23.5 % of cancers ( 4 of 17 ) deemed clinical ly insignificant on 12-core biopsy to clinical ly significant prostate cancer necessitating treatment . CONCLUSIONS Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy can improve prostate cancer detection . The results of this trial support the external validity of this platform and may be the next step in the evolution of prostate cancer management OBJECTIVES Transrectal ultrasound (TRUS)-guided r and om biopsies is the gold st and ard when diagnosing prostate cancer . A new 3D system with organ tracking , allows accurate targeted biopsies using magnetic resonance imaging ( MRI ) and TRUS soft image fusion . The aim of the study was to evaluate the accuracy of targeted biopsies . MATERIAL S AND METHODS Retrospective study of 90 consecutive patients with suspected prostate cancer underwent MRI prior to biopsy using 3D T2w and diffusion weighted imaging ( 12 min  protocol ) . Suspicious tumours ( MRI targets ) were highlighted on axial T2w images and classified as high , moderate or low degree of cancer suspicion . Navigation system : Urostation(Koelis ® , Grenoble , France ) . Primary endpoint : Rate of successful targeted biopsies . Positive biopsies with Gleason score . RESULTS MRI was positive in 80/90 ( 89 % ) patients , in which 115 MRI targets were identified and biopsied . There were 112/115 ( 97 % ) successful biopsies inside target , and 60/115 ( 52 % ) targets were positive for cancer . Positive biopsies according to degree of cancer suspicion were : high 50/55 ( 91 % ) , medium 6/22 ( 27 % ) and low 4/38 ( 10 % ) . All MRI-negative patients had negative r and om biopsies . CONCLUSION The high rate ( 97 % ) of successful biopsies in this study indicates that targeted biopsies using MRI and TRUS soft image fusion technique might be an accurate method PURPOSE To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy ( TB ) with that of extended systematic biopsy ( SB ) in prostate cancer ( PCa ) detection . MATERIAL S AND METHODS This institutional review board-approved multicenter prospect i ve study ( May 2009 to January 2011 ) included 95 patients with informed consent who were suspected of having PCa , with a suspicious abnormality ( target ) at prebiopsy MR . Patients underwent  12-core SB and four-core TB with transrectal ultrasonographic ( US ) guidance , with two cores aim ed visually ( cognitive TB [ TB-COG ] ) and two cores aim ed using transrectal US-MR fusion software ( fusion-guided TB [ TB-FUS ] ) . SB and TB positivity for cancer and sampling quality ( mean longest core cancer length , Gleason score ) were compared . Clinical ly significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB . Statistical analysis included t test , paired χ(2 ) test , and κ statistic . Primary end point ( core cancer length ) was calculated ( paired t test ) . RESULTS Among 95 patients ( median age , 65 years ;  mean prostate-specific antigen level  , 10.05 ng/mL [ 10.05 μg/L ] ) , positivity rate for PCa was 59 % ( n = 56 ) for SB and 69 % ( n = 66 ) for TB ( P = .033 ) ; rate for clinical ly significant PCa was 52 % ( n = 49 ) for SB and 67 % ( n = 64 ) for TB ( P = .0011 ) . Cancer was diagnosed through TB in 16 patients ( 17 % ) with negative SB results . Mean longest core cancer lengths were 4.6 mm for SB and 7.3 mm for TB ( P < .0001 ) . In 12 of 51 ( 24 % ) MR imaging targets with 
    Output:
    
In men with clinical suspicion of prostate cancer and a subsequent positive MRI , MRI-TBx and TRUS-Bx did not differ in overall prostate cancer detection .
However , MRI-TBx had a higher rate of detection of significant prostate cancer and a lower rate of detection of insignificant prostate cancer compared with TRUS-Bx .
We found evidence to suggest that MRI-guided targeted biopsy benefits the diagnosis of prostate cancer