• Valeria Panebianco, Flavio Barchetti, Alessandro Sciarra, Antonio Ciardi, Elena Lucia Indino, Rocco Papalia, Michele Gallucci, Vincenzo Tombolini, Vincenzo Gentile, and Carlo Catalano.
• Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy. Electronic address: valeria.panebianco@gmail.com.
• Urol. Oncol. 2015 Jan 1; 33 (1): 17.e1-17.e7.

ObjectivesTo assess whether the proportion of men with clinically significant prostate cancer (PCa) is higher among men randomized to multiparametric magnetic resonance imaging (mp-MRI)/biopsy vs. those randomized to transrectal ultrasound (TRUS)-guided biopsy.MethodsIn total, 1,140 patients with symptoms highly suggestive of PCa were enrolled and divided in 2 groups of 570 patients to follow 2 different diagnostic algorithms. Group A underwent a TRUS-guided random biopsy. Group B underwent an mp-MRI and a TRUS-guided targeted+random biopsy. The accuracy of mp-MRI in the diagnosis of PCa was calculated using prostatectomy as the standard of reference.ResultsIn group A, PCa was detected in 215 patients. The remaining 355 patients underwent an mp-MRI: the findings were positive in 208 and unremarkable in 147 patients. After the second random+targeted biopsy, PCa was detected in 186 of the 208 patients. In group B, 440 patients had positive findings on mp-MRI, and PCa was detected in 417 at first biopsy; 130 group B patients had unremarkable findings on both mp-MRI and biopsy. In the 130 group B patients with unremarkable findings on mp-MRI and biopsy, a PCa Gleason score of 6 or precancerous lesions were detected after saturation biopsy. mp-MRI showed an accuracy of 97% for the diagnosis of PCa.ConclusionsThe proportion of men with clinically significant PCa is higher among those randomized to mp-MRI/biopsy vs. those randomized to TRUS-guided biopsy; moreover, mp-MRI is a very reliable tool to identify patients to schedule in active surveillance.Copyright © 2014 Elsevier Inc. All rights reserved.

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