***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: BACKGROUND Markers that predict the behaviour of localised prostate cancer are needed to identify patients that require treatment . OBJECTIVE We have analysed the apparent diffusion coefficient ( ADC ) generated from diffusion-weighted magnetic resonance imaging ( DW-MRI ) with respect to repeat biopsy findings and time to radical treatment in patients in a prospect i ve study of active surveillance . DESIGN , SETTING , AND PARTICIPANTS Some 86 men recruited between 2002 and 2006 were followed for a median of 29 mo . Patients had clinical stage T1/T2a N0/Nx M0/Mx adenocarcinoma of the prostate , prostate-specific antigen ( PSA ) level<15 ng/ml , Gleason score≤7 , primary Gleason grade ≤3 , and positive biopsy cores (pbc)≤50 % . MEASUREMENTS All patients had DW-MRI in addition to st and ard MRI sequences . Tumour regions of interest ( ROIs ) were identified using T2-weighted fast-spin echo images as focal areas of restricted diffusion . Univariate analyses including all clinical variables and tumour ADC data were performed with respect to repeat biopsy findings and time to radical treatment . Receiver operating curves ( ROC ) compared predictive variables . RESULTS AND LIMITATIONS Patients in the study had a median age of 66 yr and a median initial PSA level of 6.7 ng/ml . Some 39 patients ( 45 % ) received deferred radical treatment , and 34 patients ( 40 % ) had adverse histology on repeat biopsy . According to univariate analysis , tumour ADC was a significant predictor of both adverse repeat biopsy findings ( p<0.0001 ; hazard ratio [ HR ] : 1.3 ; 95 % confidence interval [ CI ] : 1.1 - 1.6 ) , and time to radical treatment ( p<0.0001 ; HR : 1.5 ; 95 % CI : 1.2 - 1.8 ) . ROC curves for ADC showed an area under the curve ( AUC ) of 0.7 for prediction of adverse repeat biopsy findings and an AUC of 0.83 for prediction of radical treatment . CONCLUSIONS In patients with low-risk , localised disease  , tumour ADC on DW-MRI may be a useful marker of prostate cancer progression and may help to identify patients who st and to benefit from radical treatment . This possibility warrants further study 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 This prospect i ve study of comparing transperineal prostate biopsy ( TPBx ) with transrectal prostate biopsy ( TRBx ) was aim ed to provide evidence for clinicians to select the appropriate biopsy approach under different conditions . TPBx ( n = 173 ) and TRBx ( n = 166 ) were performed r and omly for 339 patients who were suspicious of prostate cancer ( PCa ) . The cancer detection rate ( CDR ) , complication rate , visual analogue scale ( VAS ) score , most painful procedure , number of repeated biopsy and additional anesthesia , and operating time ( starting from lying down on the operating table to getting up ) were recorded . The results showed that TPBx and TRBx were equivalent in CDR ( 35.3 % vs. 31.9 % ) and minor complication rate ( 44.9 % vs. 41.0 % ) ( both P > 0.05 ) . The major complication rate was lower in TPBx than in TRBx ( 0.6 % vs. 4.3 % , P < 0.05 ) . TPBx was more time-consuming ( 17.51 ± 3.33 min vs. 14.73 ± 3.25 min ) and painful ( VAS score : 4.0 vs. 2.0 ) ; and it had higher rates of repeated biopsy ( 3.2 % vs. 1.1 % ) and additional anesthesia ( 15.0 % vs. 1.2 % ) ( all P < 0.05 ) . In summary , both TPBx and TRBx are effective to detect PCa . The major complication rate for TRBx is higher , whereas TPBx procedure is more complex and painful PURPOSE Men with localized prostate cancer currently face a number of treatment options that treat the entire prostate . These can cause significant sexual and urinary side effects .  Focal therapy offers a novel strategy that targets the cancer rather than the prostate in an attempt to preserve tissue and function . MATERIAL S AND METHODS A prospect i ve , ethics committee approved trial was conducted to determine the side effects of focal therapy using high intensity focused ultrasound . Multiparametric magnetic resonance imaging ( T2-weighted , dynamic contrast enhanced , diffusion-weighted ) and template transperineal prostate mapping biopsies were used to identify unilateral disease . Genitourinary side effects and quality of life outcomes were assessed using vali date d question naires . Posttreatment biopsies were performed at 6 months and followup was completed to 12 months . RESULTS A total of 20 men underwent high intensity focused ultrasound hemiablation .  Mean age was 60.4 years ( SD 5.4 , range 50 to 70 ) with mean prostate specific antigen 7.3 ng/ml ( SD 2.8 , range 3.4 to 11.8 ) . Of the men 25 % had low risk and 75 % had intermediate risk cancer .  Return of erections sufficient for penetrative sex occurred in 95 % of men ( 19 of 20 ) . In addition , 90 % of men ( 18 of 20 ) were pad-free , leak-free continent while 95 % were pad-free . Mean prostate specific antigen decreased 80 % to 1.5 ng/ml ( SD 1.3 ) at 12 months . Of the men 89 % ( 17 of 19 , 1 refused biopsy ) had no histological evidence of any cancer , and none had histological evidence of high volume or Gleason 7 or greater cancer in the treated lobe . In addition , 89 % of men achieved the trifecta status of pad-free , leak-free continence , erections sufficient for intercourse and cancer control at 12 months . CONCLUSIONS Our results appear sufficiently promising to support the further evaluation of focal therapy as a strategy to decrease some of the harms and costs associated with st and ard whole gl and treatments Summary Background Radical whole-gl and therapy can lead to significant genitourinary and rectal side-effects for men with localised prostate cancer . We report on whether selective focal ablation of unifocal and multifocal cancer lesions can reduce this treatment burden . Methods Men aged 45–80 years were eligible for this prospect i ve development study if they had low-risk to high-risk localised prostate cancer ( prostate specific antigen [ PSA ] ≤15 ng/mL , Gleason score ≤4 + 3 , stage ≤T2 ) , with no previous and rogen deprivation or treatment for prostate cancer , and who could safely undergo multiparametric MRI and have a general anaesthetic . Patients received focal therapy using high-intensity focused ultrasound , delivered to all known cancer lesions , with a margin of normal tissue , identified on multiparametric MRI , template prostate-mapping biopsies , or both . Primary endpoints were adverse events ( serious and otherwise ) and urinary symptoms and erectile function assessed using patient question naires . Analyses were done on a per- protocol basis . This study is registered with Clinical Trials.gov , number NCT00561314 . Findings 42 men were recruited between June 27 , 2007 , and June 30 , 2010 ; one man died from an unrelated cause ( pneumonia ) 3 months after treatment and was excluded from analyses . After treatment , one man was admitted to hospital for acute urinary retention , and another had stricture interventions requiring hospital admission . Nine men ( 22 % , 95 % CI 11–38 ) had self-resolving , mild to moderate , intermittent dysuria ( median duration 5·0 days [ IQR 2·5–18·5 ] ) . Urinary debris occurred in 14 men ( 34 % , 95 % CI 20–51 ) , with a median duration of 14·5 days ( IQR 6·0–16·5 ) . Urinary tract infection was noted in seven men ( 17 % , 95 % CI 7–32 ) . Median overall International Index of Erectile Function-15 ( IIEF-15 ) scores were similar at baseline and at 12 months ( p=0·060 ) , as were median IIEF-15 scores for intercourse satisfaction ( p=0·454 ) , sexual desire ( p=0·644 ) , and overall satisfaction ( p=0·257 ) . Significant deteriorations between baseline and 12 months were noted for IIEF-15 erectile ( p=0·042 ) and orgasmic function ( p=0·003 ) . Of 35 men with good baseline function , 31 ( 89 % , 95 % CI 73–97 ) had erections sufficient for penetration 12 months after focal therapy . Median UCLA Exp and ed Prostate Cancer Index Composite ( EPIC ) urinary incontinence scores were similar at baseline as and 12 months ( p=0·045 ) . There was an improvement in lower urinary tract symptoms , assessed by International Prostate Symptom Score ( IPSS ) , between baseline and 12 months ( p=0·026 ) , but the IPSS- quality of life score showed no difference between baseline and 12 months ( p=0·655 ) . All 38 men with no baseline urinary incontinence were leak-free and pad-free by 9 months . All 40 men pad-free at baseline were pad-free by 3 months and maintained pad-free continence at 12 months . No significant difference was reported in median Trial Outcomes Index scores between baseline and 12 months ( p=0·113 ) but significant improvement was shown in median Functional Assessment of Cancer Therapy (FACT)-Prostate ( p=0·045 ) and median FACT-General scores ( p=0·041 ) . No histological evidence of cancer was identified in 30 of 39 men biopsied at 6 months ( 77 % , 95 % CI 61–89 ) ; 36 ( 92 % , 79–98 ) were free of clinical ly significant cancer . After retreatment in four men , 39 of 41 ( 95 % , 95 % CI 83–99 ) had no evidence of disease on multiparametric MRI at 12 months . Interpretation Focal therapy of individual prostate cancer lesions , whether multifocal or unifocal , leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinical ly significant prostate cancer . Funding Medical Research Council ( UK ) , Pelican Cancer Foundation , and St Peters Trust BACKGROUND The incidence of small , localised , well-differentiated prostate cancer ( PCa ) is increasing , mainly as a result of screening . Many of these cancers will not progress , and radical therapy may lead to substantial overtreatment . Active surveillance ( AS ) has emerged as an alternative . OBJECTIVE To retrospectively vali date the currently used criteria for eligibility for AS . 
    Output:
    
A systematic review and meta- analysis showed that MRI-targeted biopsy detected csPCa at a significantly higher rate than did TRUS-guided biopsy , while it detected significantly fewer cases of insignificant PCas .
In addition to the high accuracy of MRI-targeted biopsy for csPCa , localization of csPCa is accurate .
The ability to choose the route of biopsy ( transperineal vs. transrectal ) is required , depending on the patients ' risk and the location and size of suspicious lesions on mpMRI .