***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 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 , while increasing the detection of high grade cancer . CONCLUSIONS When performed with computerized magnetic resonance imaging-transrectal ultrasound image registration , targeted biopsy alone improved cancer detection over r and om biopsies , decreased the detection rate of microfocal cancer and increased the detection rate of cancer with a Gleason score of greater than 6 IMPORTANCE Targeted magnetic resonance (MR)/ultrasound fusion prostate biopsy has been shown to detect prostate cancer . The implication s of targeted biopsy alone vs st and ard extended-sextant biopsy or the 2 modalities combined are not well understood . OBJECTIVE To assess targeted vs st and ard biopsy and the 2 approaches combined for the diagnosis of intermediate- to high-risk prostate cancer . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1003 men undergoing both targeted and st and ard biopsy concurrently from 2007 through 2014 at the National Cancer Institute in the United States . Patients were referred for elevated level of prostate-specific antigen ( PSA ) or abnormal digital rectal examination results , often with prior negative biopsy results . Risk categorization was compared among targeted and st and ard biopsy and , when available , whole-gl and pathology after prostatectomy as the " gold st and ard . " INTERVENTIONS Patients underwent multiparametric prostate magnetic resonance imaging to identify regions of prostate cancer suspicion followed by targeted MR/ultrasound fusion biopsy and concurrent st and ard biopsy . MAIN OUTCOMES AND MEASURES The primary objective was to compare targeted and st and ard biopsy approaches for detection of high-risk prostate cancer ( Gleason score ≥ 4 + 3 ) ; secondary end points focused on detection of low-risk prostate cancer ( Gleason score 3 + 3 or low-volume 3 + 4 ) and the biopsy ability to predict whole-gl and pathology at prostatectomy . RESULTS Targeted MR/ultrasound fusion biopsy diagnosed 461 prostate cancer cases , and st and ard biopsy diagnosed 469 cases . There was exact agreement between targeted and st and ard biopsy in 690 men ( 69 % ) undergoing biopsy . Targeted biopsy diagnosed 30 % more high-risk cancers  vs st and ard biopsy ( 173 vs 122 cases , P < .001 ) and 17 % fewer low-risk cancers ( 213 vs 258 cases , P < .001 ) . When st and ard biopsy cores were combined with the targeted approach , an additional 103 cases ( 22 % ) of mostly low-risk prostate cancer were diagnosed ( 83 % low risk , 12 % intermediate risk , and 5 % high risk ) . The predictive ability of targeted biopsy for differentiating low-risk from intermediate- and high-risk disease in 170 men with whole-gl and pathology after prostatectomy was greater than that of st and ard biopsy or the 2 approaches combined ( area under the curve , 0.73 , 0.59 , and 0.67 , respectively ; P < .05 for all comparisons ) . CONCLUSIONS AND RELEVANCE Among men undergoing biopsy for suspected prostate cancer , targeted MR/ultrasound fusion biopsy , compared with st and ard extended-sextant ultrasound-guided biopsy , was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer . Future studies will be needed to assess the ultimate clinical implication s of targeted biopsy . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00102544 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 PURPOSE We evaluated biochemical parameters and pathological features , as well as biopsy related morbidity of prostate cancer detected on biopsies 2 , 3 and 4 in men with total serum prostate specific antigen ( PSA ) between 4 and 10 ng./ml . These features were compared to those detected on prostate biopsy 1 . MATERIAL S AND METHODS In this prospect i ve European Prostate Cancer Detection study 1,051 men with total PSA between 4 and 10 ng./ml . underwent transrectal ultrasound guided sextant biopsy and 2 additional transition zone biopsies .  All patients in whom biopsy sample s were negative for prostate cancer underwent biopsy 2 after 6 weeks . If also negative , biopsies 3 and even 4 were performed at 8-week intervals . Those patients with clinical ly localized cancer underwent radical prostatectomy . Pathological and clinical features of patients diagnosed with cancer on either biopsy 1 or 2 and clinical ly organ confined disease who agreed to undergo radical prostatectomy were compared . RESULTS Cancer detection rates on biopsies 1 , 2 , 3 and 4 were 22 % ( 231 of 1,051 ) , 10 % ( 83 of 820 ) , 5 % ( 36 of 737 ) and 4 % ( 4 of 94 ) , respectively . Overall , of the patients with clinical ly localized disease , which was 67 % of cancers detected , 86 % underwent radical prostatectomy and 14 % opted for watchful waiting or radiation therapy . Overall , 58.0 % , 60.9 % , 86.3 % and 100 % of patients had organ confined disease on biopsies 1 , 2 , 3 and 4 , respectively . Despite statistically significant differences in regard to multifocality ( p = 0.009 ) and cancer location ( p = 0.001 ) , including cancer on biopsy 2 showing a lower rate of multifocality and a more apico-dorsal location , there were no differences in regard to stage ( p = 0.2 ) , Gleason score ( p = 0.3 ) , percent Gleason grade 4/5 ( p = 0.2 ) , serum PSA and patient age between biopsies 1 and 2 . However , cancer detected on biopsies 3 and 4 had a significantly lower Gleason score ( p = 0.001 and 0.001 ) , lower rate of grade 4/5 ( p = 0.02 ) , and lower volume ( p = 0.001 and 0.001 ) and stage ( p = 0.001 ) , respectively . CONCLUSIONS Despite differences in location and multifocality , pathological and biochemical features of cancer detected on biopsies 1 and 2 were similar , suggesting comparable biological behaviors . Cancer detected on biopsies 3 and 4 had a lower grade , stage and volume compared with that on biopsies 1 and 2 . Morbidity on biopsies 1 and 2 was similar , whereas biopsies 3 and 4 had a slightly higher complication rate . Therefore , biopsy 2 in all cases of a negative finding on biopsy 1 appears justified . However , biopsies 3 and 4 should only be obtained in select patients with a high suspicion of cancer and /or poor prognostic factors on biopsy 1 or 2 Purpose : To evaluate multiparametric magnetic resonance imaging/transrectal ultrasound ( mpMRI/TRUS 
    Output:
    
No clear advantage of MRI/US fusion-guided TBs was seen for cancer detection rates ( CDRs ) of all prostate cancers .
However , MRI/US fusion-guided TBs tended to give higher CDRs for clinical ly significant prostate cancers in our analysis .
Today , a limited number of prospect i ve studies have reported the CDRs of fusion platforms .