***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 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 A deformable registration method is described that enables automatic alignment of magnetic resonance ( MR ) and 3D  transrectal ultrasound ( TRUS ) images of the prostate gl and . The method employs a novel " model-to-image " registration approach in which a deformable model of the gl and surface , derived from an MR image , is registered automatically to a TRUS volume by maximising the likelihood of a particular model shape given a voxel-intensity-based feature that represents an estimate of surface normal vectors at the boundary of the gl and . The deformation of the surface model is constrained by a patient-specific statistical model of gl and deformation , which is trained using data provided by biomechanical simulations . Each simulation predicts the motion of a volumetric finite element mesh due to the r and om placement of a TRUS probe in the rectum . The use of biomechanical modelling in this way also allows a dense displacement field to be calculated within the prostate , which is then used to non-rigidly warp the MR image to match the TRUS image . Using data acquired from eight patients , and anatomical l and marks to quantify the registration accuracy , the median final RMS target registration error after performing 100 MR-TRUS registration s for each patient was 2.40 mm PURPOSE Multiparametric magnetic resonance imaging appears to improve prostate cancer detection but prospect i ve studies are lacking . We determined the accuracy of multiparametric magnetic resonance imaging for detecting significant prostate cancer before diagnostic biopsy in men with abnormal prostate specific antigen/digital rectal examination . MATERIAL S AND METHODS In this single center , prospect i ve study men older than 40 years with abnormal prostate specific antigen/digital rectal examination and no previous multiparametric magnetic resonance imaging underwent T2-weighted , diffusion-weighted and dynamic contrast enhanced imaging without an endorectal coil . Imaging was allocated alternately to 1.5/3.0 Tesla . Imaging was double reported independently using PI-RADS ( Prostate Imaging Reporting and Data System ) by specialist radiologists . Transperineal grid directed 30-core biopsy was performed with additional magnetic resonance imaging directed cores for regions of interest outside template locations . Four significant cancer definitions were tested . Chi-square and logistic regression analysis was done . Men undergoing prostatectomy were analyzed . RESULTS Of the 165 men who enrolled in the study 150 were analyzed . Median age was 62.4 years , median prostate specific antigen was 5.6 ng/ml , 29 % of patients had an abnormal digital rectal examination and 88 % underwent initial biopsy .  Multiparametric magnetic resonance imaging  was positive ( PI-RADS 3 to 5 ) in 66 % of patients , 61 % had prostate cancer and 30 % to 41 % had significant prostate cancer ( definitions 1 to 4 ) . For significant cancer sensitivity was 93 % to 96 % , specificity was 47 % to 53 % , and negative and positive predictive values were 92 % to 96 % and 43 % to 57 % , respectively ( definitions 1 to 4 ) . Radical prostatectomy results in 48 men were similar . Aggregate PI-RADS ( 4 to 20 ) performed similarly to overall PI-RADS ( 1 to 5 ) . Negative and positive predictive values ( 100 % and 71 % , respectively ) were similar in men at higher risk , defined as prostate specific antigen greater than 10 ng/ml with abnormal digital rectal examination . On multivariate analysis PI-RADS score was associated with significant prostate cancer ( p < 0.001 ) but magnet strength was not . Adding PI-RADS to the multivariate model improved the AUC from 0.810 to 0.913 ( 95 % CI 0.038 - 0.166 , p = 0.002 ) . Radiologist agreement was substantial ( weighted κ = 0.626 ) . CONCLUSIONS Multiparametric magnetic resonance imaging reported by expert radiologists achieved an excellent negative predictive value and a moderate positive predictive value for significant prostate cancer at 1.5 and 3.0 Tesla Background : Identification of men harbouring insignificant prostate cancer ( PC ) is important in selecting patients for active surveillance . Tools have been developed in PSA-screened population s to identify such men based on clinical and biopsy parameters . Methods : Prospect ively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre .  Tumour volume was assessed by pathological examination . For each tool , receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared . Comparison of accuracy in screened and unscreened population s was performed . Results : Of 848 patients , 415 had Gleason 3 + 3 disease on biopsy . Of these , 32.0 % had extra-prostatic extension and 50.2 % were up grade d. One had positive lymph nodes . Two hundred and six ( 24 % of cohort ) were D’Amico low risk . Of these , 143 had more than two biopsy cores involved . None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden . Accuracy is low in PSA-screened and -unscreened population s. Conclusions : In our unscreened population , tools design ed to identify insignificant PC are inaccurate . Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy OBJECTIVE The primary objective of the PICTURE study is to assess the negative predictive value of multi-parametric MRI ( mp-MRI ) and Prostate HistoScanning ™ ( PHS ) in ruling-out clinical ly significant prostate cancer . PATIENTS AND METHODS PICTURE is a prospect i ve diagnostic validating cohort study conforming to level 1 evidence . PICTURE will assess the diagnostic performance of multi-parametric Magnetic Resonance Imaging ( mp-MRI ) and Prostate HistoScanning ™ ( PHS ) ultrasound . PICTURE will involve validating both index tests against a reference test , transperineal Template Prostate Mapping ( TPM ) biopsies , which can be applied in all men under evaluation . Men will be blinded to the index test results and both index tests will be reported prospect ively prior to the biopsies being taken to ensure reporter blinding . Paired analysis of each of the index tests to the reference test will be done at patient level . Those men with an imaging lesion will undergo targeted biopsies to assess the clinical utility of sampling only suspicious areas . The study is powered to assess the negative predictive value of these imaging modalities in ruling-out clinical ly significant prostate cancer . DISCUSSION The PICTURE study aims to assess the performance characteristics of two imaging modalities ( mp-MRI and Prostate HistoScanning ) for their utility in the prostate cancer pathway . PICTURE aims to identify if either imaging test may be useful for ruling out clinical ly significant disease in men under investigation , and also to examine if either imaging modality is useful for the detection of disease . Recruitment is underway and expected to complete in 2014 PURPOSE We compared the accuracy of visual targeted biopsies vs computerized transrectal ultrasound-magnetic resonance imaging registration using a rigid ( Esaote ® , nondeformable ) or elastic ( Koelis ® , deformable ) approach . MATERIAL S AND METHODS A total of 391 consecutive patients with suspected localized prostate cancer were prospect ively included in analysis . All patients underwent prostate magnetic resonance imaging , followed by 10 to 12-core r and om prostate biopsies .  When magnetic resonance imaging detected suspicious findings , targeted biopsy was performed , including visual , rigid system and elastic system targeted biopsies in the first 127 patients , the next 131 and the last 133 , respectively . Cancer detection rates were assessed by conditional logistic regression . Targeted biopsies alone and r and om biopsies were further compared for the amount of tissue sample d and microfocal cancer detection , the latter defined as a single core with 5 mm or less of Gleason 6 cancer . RESULTS Patient characteristics and r and om biopsy detection rates were similar among the groups . Magnetic resonance imaging detected at least 1 suspicious area in 54 ( 42 % ) , 78 ( 59 % ) and 82 patients ( 62 % ) in groups 1 , 2 and 3 , respectively . The cancer detection rates of rigid and elastic system targeted biopsies were significantly higher than the r and om biopsy rate ( p = 0.0065 and 0.0016 , respectively ) . Visual targeted biopsy did not perform better than r and om biopsy ( p = 0.66 ) . Rigid and elastic system targeted biopsies allowed for decreasing the number of cores and the detection of microfocal cancer 
    Output:
    
Software-based MRI-US fusion targeted biopsy seems to detect more clinical ly significant cancers deploying fewer cores than st and ard biopsy .
PATIENT SUMMARY We compared the ability of st and ard biopsy to diagnose prostate cancer against a novel approach using software to overlay the images from magnetic resonance imaging and ultrasound to guide biopsies towards the suspicious areas of the prostate .