***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 : The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System ( PI-RADS ) for st and ardizing the diagnosis of prostate cancer ( PCa ) . This study evaluated the PI-RADS diagnosis method in patients with prostate-specific antigen ( PSA ) < 20 ng/ml . Methods : A total of 133 patients with PSA < 20 ng/ml were prospect ively recruited .  T2-weighted ( T2WI ) and diffusion-weighted ( DWI ) magnetic resonance images of the prostate were acquired before a 12-core transrectal prostate biopsy . Each patient 's peripheral zone was divided into six regions on the images ; each region corresponded to two of the 12 biopsy cores . T2WI , DWI , and T2WI + DWI scores were computed according to PI-RADS . The diagnostic accuracy of the PI-RADS score was evaluated using histopathology of prostate biopsies as the reference st and ard . Results : PCa was histologically diagnosed in 169 ( 21.2 % ) regions . Increased PI-RADS score correlated positively with increased cancer detection rate . The cancer detection rate for scores 1 to 5 was 2.8 % , 15.0 % , 34.6 % , 52.6 % , and 88.9 % , respectively , using T2WI and 12.0 % , 20.2 % , 48.0 % , 85.7 % , and 93.3 % , respectively , using DWI . For T2WI + DWI , the cancer detection rate was 1.5 % ( score 2 ) , 13.5 % ( scores 3–4 ) , 41.3 % ( scores 5–6 ) , 75.9 % ( scores 7–8 ) , and 92.3 % ( scores 9–10 ) . The area under the curve for cancer detection was 0.700 ( T2WI ) , 0.735 ( DWI ) and 0.749 ( T2WI + DWI ) . The sensitivity and specificity were 53.8 % and 89.2 % , respectively , when using scores 5–6 as the cutoff value for T2WI + DWI . Conclusions : The PI-RADS score correlates with the PCa detection rate in patients with PSA < 20 ng/ml . The summed score of T2WI + DWI has the highest accuracy in detection of PCa . However , the sensitivity should be further improved PURPOSE In patients with a negative prostate biopsy and persistent suspicion of prostate cancer , additional analyses such as the PCA3 score , PHI and multiparametric magnetic resonance imaging have been proposed to reduce the number of unnecessary repeat biopsies . In this study we evaluate the diagnostic accuracy of PCA3 , PHI , multiparametric magnetic resonance imaging and various combinations of these tests in the repeat biopsy setting . MATERIAL S AND METHODS A total of 170 patients with an initial negative prostate biopsy and persistent suspicion of prostate cancer were enrolled in this prospect i ve study . The patients underwent measurements of the total prostate specific antigen and free prostate specific antigen rate , along with PHI , PCA3 tests and multiparametric magnetic resonance imaging before st and ard repeat biopsy that was performed by urologists blinded to the multiparametric magnetic resonance imaging results . Multivariate logistic regression models with various combinations of PCA3 , PHI and multiparametric magnetic resonance imaging were used to identify the predictors of prostate cancer with repeat biopsy , and the performance of these models was compared using ROC curves , AUC analysis and decision curve analysis . RESULTS In the ROC analysis the most significant contribution was provided by multiparametric magnetic resonance imaging ( AUC 0.936 ) , which was greater than the contribution of the PHI+PCA3 model ( p < 0.001 ) . In the multivariate logistic regression analysis only multiparametric magnetic resonance imaging was a significant independent predictor of prostate cancer diagnosis with repeat biopsy ( p < 0.001 ) . The results of the decision curve analysis confirmed that the most significant improvement in the net benefit was provided by multiparametric magnetic resonance imaging . CONCLUSIONS Multiparametric magnetic resonance imaging provides high diagnostic accuracy in identifying patients with prostate cancer in the repeat biopsy setting compared with PCA3 and PHI PURPOSE To evaluate the role of a 3 T biparametric magnetic resonance imaging ( bpMRI ) , T2 -weighted imaging , and three separate diffusion-weighted imaging acquisitions combined with targeted biopsy ( TB ) for improving risk stratification of men with elevated prostate-specific antigen ( PSA ) . MATERIAL S AND METHODS Between March 2013 and February 2015 , 175 men with a clinical suspicion of prostate cancer ( PCa ) were offered bpMRI  ( NCT01864135 ) based on a suspicion of PCa ( two repeated PSA measurements in the range 2.5 - 20.0 ng/ml and /or abnormal digital rectal examination ) . Men with an equivocal to high suspicion of PCa had two TBs of the dominant lesion using cognitive ultrasound guidance , followed by systematic biopsy ( SB ) . Men with a low to very low suspicion had only SB . In total , 161 ( 161/175 , 92 % ) prospect ively enrolled men completed the trial and were included in the final analyses . The primary endpoint of the trial was the cancer detection rate ( CDR ) of TB and SB . Clinical ly significant cancer ( SPCa ) was defined as Gleason score ≥3 + 4 . RESULTS TB compared with SB had higher CDR for SPCa ( 45 % , 72/161 vs. 39 % , 63/161 , respectively ; P > 0.05 ) and a lower CDR for Gleason score 3 + 3 ( 8 % , 15/161 vs. 16 % , 30/161 ; P < 0.05 ) . Restricting biopsy to men with equivocal to highly suspicious bpMRI findings would have result ed in a 24 % ( 38/161 ) reduction in the number of men undergoing biopsy , while missing 4 ( 2 % ) with SPCa . All anonymized data sets , including bpMRI reports and follow up information , are freely available on the trial server . CONCLUSION Prebiopsy bpMRI and TB in men with a clinical suspicion of PCa improved risk stratification . LEVEL OF EVIDENCE 1 Technical Efficacy : Stage 5 J. Magn . Reson . Imaging 2017;46:1089 - 1095 OBJECTIVE Multiparametric MRI ( mp-MRI ) of the prostate is increasingly being used for local staging and detection of recurrence of prostate cancer ( PCA ) . In patients with elevated prostate-specific antigen ( PSA ) , mp-MRI could provide information on the position of the cancer , allowing adjustments to be made to the needle depth and direction before repeat transrectal ultrasound (TRUS)-guided biopsy to ensure accurate sampling of lesions . The purpose of the prospect i ve study was to evaluate mp-MRI of the prostate in patients with PSA elevation before initial TRUS-guided biopsy . METHODS  mp-MRI was performed in 94 patients using a 1.5-T scanner ( MAGNETOM Aera ( ® ) ; Siemens Healthcare , Erlangen , Germany ) and 16-channel phased-array body coil ( Siemens Healthcare ) . T2 weighted images ( T2WI ) , diffusion-weighted imaging ( DWI ) , dynamic contrast-enhanced ( DCE ) MRI and MR spectroscopy were obtained . TRUS-guided r and om biopsies and additional targeted biopsies of suspicious MRI areas were performed . RESULTS Additional targeted biopsies were obtained in 17 of 43 ( 40 % ) patients with PCA . 11 of 17 targeted biopsies contained PCA . 5 of 11 PCAs were diagnosed only by additional targeted biopsies . Sensitivity of mp-MRI  in patients was 97.7 % and specificity was 11.8 % .  mp-MRI was false negative in one patient . Sensitivity of mp-MRI in 207 lesions was 80.9 % and specificity was 44.7 % . In a logistic regression model , the apparent diffusion coefficient value was the only significant parameter to differentiate malignant and benign lesions . CONCLUSION mp-MRI should be performed in patients with PSA elevation before initial TRUS-guided biopsy to allow additional targeted biopsies from suspicious areas of MRI . We recommend mp-MRI with T2WI , DWI , DCE MRI and MR spectroscopy . DWI as the most reliable technique should be used in every mp-MRI . ADVANCES IN KNOWLEDGE DWI is the most reliable technique in mp-MRI of the prostate Purpose To vali date the dominant pulse sequence paradigm and limited role of dynamic contrast material -enhanced magnetic resonance ( MR ) imaging in the Prostate Imaging Reporting and Data System ( PI-RADS ) version 2 for prostate multiparametric MR imaging by using data from a multireader study . Material s and Methods This HIPAA-compliant retrospective interpretation of prospect ively acquired data was approved by the local ethics committee . Patients were treatment-naïve with endorectal coil 3-T multiparametric MR imaging . A total of 163 patients were evaluated , 110 with prostatectomy after multiparametric MR imaging and 53 with negative multiparametric MR imaging and systematic biopsy findings . Nine radiologists participated in this study and interpreted images in 58 patients , on average ( range , 56 - 60 patients ) . Lesions were detected with PI-RADS version 2 and were compared with whole-mount prostatectomy findings . Probability of cancer detection for overall , T2-weighted , and diffusion-weighted ( DW ) imaging PI-RADS scores was calculated in the peripheral zone ( PZ ) and transition zone ( TZ ) by using generalized estimating equations . To determine dominant pulse sequence and benefit of dynamic contrast-enhanced ( DCE ) imaging , odds ratios ( ORs ) were calculated as the ratio of odds of cancer of two consecutive scores by logistic regression . Results A total of 654 lesions ( 420 in the PZ ) were detected . The probability of cancer detection for PI-RADS category 2 , 3 , 4 , and 5 lesions was 15.7 % , 33.1 % , 70.5 % , and 90.7 % , respectively . DW imaging outperformed T2-weighted imaging in the PZ ( OR , 3.49 vs 2.45 ; P = .008 ) . T2-weighted imaging performed better but did not clearly outperform DW imaging in the TZ ( OR , 4.79 vs 3.77 ; P = .494 ) . Lesions classified as PI-RADS category 3 at DW MR imaging and as positive at DCE imaging in the PZ showed a higher probability of cancer detection than did DCE-negative PI-RADS category 3 lesions ( 67.8 % vs 40.0 % , P = .02 ) . The addition of DCE imaging to DW imaging in the PZ was beneficial ( OR , 2.0 ; P = .027 ) , with an increase in the probability of cancer detection of 15.7 % , 16.0 % , and 9.2 % for PI-RADS category 2 , 3 , and 4 lesions , respectively . Conclusion DW imaging outperforms T2-weighted imaging in the PZ ; T2-weighted imaging did not show a significant difference when compared with DW imaging in the TZ by PI-RADS version 2 criteria . The addition of DCE imaging to DW imaging scores in the PZ yields meaningful improvements in probability of cancer detection . © RSNA , 2017 An earlier incorrect version of this article appeared online . This article was corrected on July 27 , 2017 . Online supplemental material is available for this article Purpose To determine the diagnostic accuracy for clinical ly significant prostate cancer achieved with abbreviated biparametric prostate magnetic resonance ( MR ) imaging in comparison with full multiparametric contrast material -enhanced prostate MR imaging in men with elevated prostate-specific antigen ( PSA ) and negative transrectal ultrasonography (US)-guided biopsy findings ; to determine the significant cancer detection rate of biparametric versus full multiparametric contrast-enhanced MR imaging and between-reader agreement for interpretation of biparametric MR imaging . Material s and Methods In this institutional review board-approved retrospective review of prospect ively acquired data , men with PSA greater than or equal to 3 ng/mL after negative transrectal US-guided biopsy findings underwent state-of-the-art , full multiparametric contrast-enhanced MR imaging at 3.0-T including high-spatial-resolution structural imaging in several planes , diffusion-weighted imaging at 0 , 800 , 1000 , and 1400 mm2/sec , and dynamic contrast-enhanced MR imaging , obtained without endorectal coil within 34 minutes 19 seconds . One of four radiologists with different levels of expertise ( 1 - 9 years ) first review ed only a fraction of the full multiparametric contrast-enhanced MR images , consisting of single-plane ( axial ) structural imaging ( T2-weighted turbo spin-echo and diffusion-weighted imaging ) , acquired within 8 minutes 45 seconds ( referred to as biparametric MR imaging ) , and established a diagnosis according to the Prostate Imaging Reporting and 
    Output:
    
Results of the meta- analysis suggest that  mpMRI is a sensitive tool to diagnose prostate cancer .