***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: To examine the value of additional transrectal ultrasonography (TRUS)‐guided r and om biopsy ( RB ) in patients with negative magnetic resonance imaging (MRI)/ultrasonography ( US ) fusion‐guided targeted biopsy ( TB ) and to identify possible reasons for TB failure To analyse the performance of the Prostate Cancer Prevention Trial Risk Calculator ( PCPT‐RC ) and two iterations of the European R and omised Study of Screening for Prostate Cancer ( ERSPC ) Risk Calculator , one of which incorporates prostate volume ( ERSPC‐RC ) and the other of which incorporates prostate volume and the prostate health index ( PHI )  in a referral population ( ERSPC‐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 Purpose To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy ( TRUS-Bx ) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy ( MRI-visual-Bx ) for patients with prostate specific antigen ( PSA ) level less than 10 ng/mL. Material s and Methods In total , 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospect ively in 2014 . In patients with abnormal lesions on mp-MRI , we performed additional  MRI-visual-Bx . We compared pathologic results , including the rate of clinical ly significant prostate cancer cores ( cancer length greater than 5 mm and /or any Gleason grade greater than 3 in the biopsy core ) . Results The mean PSA was 6.43 ng/mL. In total , 48 of 76 ( 63.2 % ) patients had abnormal lesions on mp-MRI , and 116 targeted biopsy cores , an average of 2.42 per patient , were taken . The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 ( 34.2 % ) and 23/48 ( 47.9 % ) , respectively . In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores , the positive rates were 8.4 % ( 77 of 912 cores ) and 46.6 % ( 54 of 116 cores ) , respectively ( p<0.001 ) . Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5 % , respectively , in TRUS-Bx and 6.3 mm and 45.4 % in MRI-visual-Bx ( p<0.001 ) . In addition , Gleason score ≥7 was noted more frequently using MRI-visual-Bx ( p=0.028 ) . The detection rate of clinical ly significant prostate cancer was 27/77 ( 35.1 % ) and 40/54 ( 74.1 % ) for TRUS-Bx and MRI-visual-Bx , respectively ( p<0.001 ) . Conclusion MRI-visual-Bx showed better performance in the detection of clinical ly significant prostate cancer , compared to TRUS-Bx among patients with a PSA level less than 10 Background Multiparametric-magnetic resonance imaging ( mpMRI ) can accurately detect high- grade and larger  prostate cancers ( PC ) . Aims To evaluate the ability of 1.5 T magnetic field mpMRI-targeted Prostate Biopsies ( PBx ) in predicting PC in comparison with blind 24-core saturation PBx ( sPBx ) . Methods We prospect ively collected data from patients undergoing transrectal sPBx and , if needed ,  targeted PBx of suspected lesions based on the 16-‘region-of-interest ’ ( ROI ) PI-RADS graph . Data remodeling : for each ‘ target ’ ( each suspected lesion at mpMRI ) , we identified all the 16 ‘ ROIs ’ into which the lesion extended : these single ‘ ROIs ’ were identified as ‘ macro-targets ’ . For each ‘ ROI ’ and ‘ macro-target ’ , we compared the mpMRI result with that of a saturation and targeted biopsy ( if performed ) . Results 1.5 T mpMRI showed a PI-RADS value ≥ 3 in 101 patients ( 82.1 % ) . We found a PC in 50 ( 40.6 % ) . Negative-positive predictive values for mpMRI were 82–45 % , respectively . Of the 22 patients with normal mpMRI , four had a PC , but none had a clinical ly significant cancer . After the data remodeling , we demonstrated the presence of PC in 228 ‘ ROIs ’ : ( a ) only in targeted biopsies in 15 ‘ ROIs’/’macro-targets ’ ( 6.6 % ) ; ( b ) only in sPBx in 177 ‘ ROIs ’ ( 77.6 % ) ; ( c ) in both targeted and sPBx in 36 ‘ ROIs ’ ( 15.8 % ) . Discussion 81.8 % of patients with normal 1.5 T mpMRI were negative at PBx . Performing only targeted PBx may lead to lack of PC diagnosis in about 50 % of patients . Conclusions In patients with suspected PC and a previous negative PBx , a normal mpMRI may exclude a clinical ly significant PC , avoiding sPBx Purpose To characterize clinical ly important prostate cancers missed at multiparametric ( MP ) magnetic resonance ( MR ) imaging . Material s and Methods The local institutional review board approved this HIPAA-compliant retrospective single-center study , which included 100 consecutive patients who had undergone MP MR imaging and subsequent radical prostatectomy .  A genitourinary pathologist blinded to MP MR findings outlined prostate cancers on whole-mount pathology slices . Two readers correlated mapped lesions with reports of prospect ively read MP MR images . Readers were blinded to histopathology results during prospect i ve reading . At histopathologic examination , 80 clinical ly unimportant lesions ( < 5 mm ; Gleason score , 3 + 3 ) were excluded . The same two readers , who were not blinded to histopathologic findings , retrospectively review ed cancers missed at MP MR imaging and assigned a Prostate Imaging Reporting and Data System ( PI-RADS ) version 2 score to better underst and false-negative lesion characteristics . Descriptive statistics were used to define patient characteristics , including age , prostate-specific antigen ( PSA ) level , PSA density , race , digital rectal examination results , and biopsy results before MR imaging . Student t test was used to determine any demographic differences between patients with false-negative MP MR imaging findings and those with correct prospect i ve identification of all lesions . Results Of the 162 lesions , 136 ( 84 % ) were correctly identified with MP MR imaging . Size of eight lesions was underestimated . Among the 26 ( 16 % ) lesions missed at MP MR imaging , Gleason score was 3 + 4 in 17 ( 65 % ) , 4 + 3 in one ( 4 % ) , 4 + 4 in seven ( 27 % ) , and 4 + 5 in one ( 4 % ) . Retrospective PI-RADS version 2 scores were assigned ( PI-RADS 1 , n = 8 ; PI-RADS 2 , n = 7 ; PI-RADS 3 , n = 6 ; and PI-RADS 4 , n = 5 ) . On a per-patient basis , MP MR imaging depicted clinical ly important prostate cancer in 99 of 100 patients . At least one clinical ly important tumor was missed in 26 ( 26 % ) patients , and lesion size was underestimated in eight ( 8 % ) . Conclusion Clinical ly important lesions can be missed or their size can be underestimated at MP MR imaging . Of missed lesions , 58 % were not seen or were characterized as benign findings at second-look analysis . Recognition of the limitations of MP MR imaging is important , and new approaches to reduce this false-negative rate are needed . © RSNA , 2017 Online supplemental material is available for this article BACKGROUND Multiparametric magnetic resonance imaging ( mpMRI ) is gaining widespread acceptance in prostate cancer ( PC ) diagnosis and improves significant PC ( sPC ; Gleason score≥3 + 4 ) detection . Decision making based on European R and omised Study of Screening for PC ( ERSPC ) risk-calculator ( RC ) parameters may overcome prostate-specific antigen ( PSA ) limitations . OBJECTIVE We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models ( RMs ) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy . DESIGN , SETTING , AND PARTICIPANTS We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015 . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate regression analyses were used to determine significant sPC predictors for RM development . The prediction performance was compared with ERSPC-RCs , RCs refitted on our cohort , Prostate Imaging Reporting and Data System ( PI-RADS ) v1.0 , and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics ( ROCs ) . Discrimination and calibration of the RM , as well as net decision and reduction curve analyses were evaluated based on resampling methods . RESULTS AND LIMITATIONS PSA , prostate volume , digital-rectal examination , and PI-RADS were significant sPC predictors and included in the RMs together with age . The ROC area under the curve of the RM for biopsy-naïve men was comparable with ERSPC-RC3 plus PI-RADSv1.0 ( 0.83 vs 0.84 ) but larger compared with ERSPC-RC3 ( 0.81 ) , refitted RC3 ( 0.80 ) , and PI-RADS ( 0.76 ) . For postbiopsy men , the novel RM 's discrimination ( 0.81 ) was higher , compared with PI-RADS ( 0.78 ) , ERSPC-RC4 ( 0.66 ) , refitted RC4 ( 0.76 ) , and ERSPC-RC4 plus PI-RADSv1.0 ( 0.78 ) . Both RM benefits exceeded those of ERSPC-RCs and PI-RADS in the decision regarding which patient to receive biopsy and enabled the highest reduction rate of unnecessary biopsies . Limitations include a monocentric design and a lack of PI-RADSv2.0 . CONCLUSIONS The novel RMs , incorporating clinical parameters and PI-RADS , performed significantly better compared with RMs without PI-RADS and provided measurable benefit in making the decision to biopsy men at a suspicion of PC . For biopsy-naïve patients , both our RM and ERSPC-RC3 plus PI-RADSv1.0 exceeded the prediction performance compared with clinical parameters alone . PATIENT SUMMARY Combined risk models including clinical and imaging parameters  predict clinical ly relevant prostate cancer significantly better than clinical risk calculators and multiparametric magnetic resonance imaging 
    Output:
    
Among the diagnostic strategies considered , the MRI pathway has the most favourable diagnostic accuracy in clinical ly significant prostate cancer detection .
Compared to systematic biopsy , it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed .