@article{discovery10053362,
           month = {December},
            year = {2018},
          number = {6},
           pages = {1227--1234},
           title = {Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial},
          volume = {200},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
         journal = {The Journal of Urology},
            issn = {1527-3792},
        abstract = {PURPOSE: To evaluate detection of clinically significant prostate cancer (csPCa) using MRI-targeted biopsies, and compare visual-estimation to image-fusion targeting, in patients requiring repeat prostate biopsies. MATERIALS AND METHODS: Prospective, ethics-committee approved, registered PICTURE trial enrolling 249 consecutive patients (11th/January/2012-29th/January/2014). Men underwent an mpMRI and were blinded to its results. All underwent transperineal template prostate mapping (TTPM) biopsies. In 200 with a lesion, this was preceded by visual-estimation and image-fusion targeted biopsies. For the primary endpoint, csPCa was defined as Gleason {\ensuremath{>}}/=4+3 and/or any grade of cancer length {\ensuremath{>}}/=6mm. Other definitions of csPCa were also evaluated. RESULTS: Mean (SD) age was 62.6 (7) years, median (IQR) PSA 7.17ng/ml (5.25, 10.09), mean primary lesion size 0.37cc (SD1.52), with mean 4.3 (SD2.3) targeted cores per lesion (visual-estimation and image-fusion combined) and mean 48.7 (SD12.3) TTPM-biopsy cores. TTPM-biopsies detected 97 (48.5\%) cases of csPCa and 85 (42.5\%) insignificant cancers. Overall, mpMRI-targeted biopsies detected 81 (40.5\%) csPCa and 63 (31.5\%) insignificant cancers. Eighteen (9\%) with csPCa on MRI-targeted biopsies were benign or clinically insignificant on TTPM-biopsy. Thirty-four (17\%) had csPCa detected on TTPM-biopsy but not on MRI-targeted biopsies; approximately half of these were present in non-targeted areas. csPCa was found with visual-estimation and image-fusion in 53/169 (31.3\%) and 48/169 (28.4\%) (McNemar's test, p=0.5322). Visual-estimation missed 23 (13.6\%) csPCa detected by image-fusion; image-fusion missed 18 (10.8\%) csPCa that visual-estimation detected. CONCLUSIONS: MRI-targeted biopsies are accurate at detection of csPCa and reducing over-diagnosis of insignificant cancers. To maximise detection both visual-estimation and image-fusion targeted biopsies are required.},
             url = {https://doi.org/10.1016/j.juro.2018.07.001},
          author = {Simmons, LAM and Kanthabalan, A and Arya, M and Briggs, T and Barratt, D and Charman, SC and Freeman, A and Gelister, J and Hawkes, D and Hu, Y and Jameson, C and McCartan, N and Moore, CM and Punwani, S and van der Muelen, J and Emberton, M and Ahmed, HU}
}