NEW IMAGING TECHNIQUES (S RAIS-BAHRAMI AND K PORTER, SECTION EDITORS) Developing a National Center of Excellence for Prostate Imaging Annerleim Walton-Diaz 1,2,3 & Manuel Madariaga-Venegas 1,4 & Nicolas Aviles 1,5 & Juan Carlos Roman 1,2,3 & Ivan Gallegos 1,3 & Mauricio Burotto 6,7 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review The purpose of this review is to summarize the most current literature regarding the most important aspects to consider when developing a center of excellence for prostate imaging and biopsy. Recent Findings Multiparametric MRI (mp-MRI) has changed the way we diagnose and treat prostate cancer. This imaging modality allows for more precise identification of areas suspicious in terms of harboring prostate cancer, enabling performance of targeted mp-MRI-guided biopsies that have been demonstrated to yield superior cancer detection rates. Centers worldwide are increasingly adopting this technology. However, obtaining results comparable with those findings published in the literature can be challenging. The imaging and biopsy process entails the need for a multidisciplinary team including a dedicated radiologist, urologist, and pathologist. Adequate mp-MRI interpretation for accurate lesion identification, acquaintance with the biopsy technique selected, and precise characterization of Gleason Score/Grade Groupings are equal determinants of accurate biopsy results. Furthermore, all specialists are required to attain appropriate learning curves to ensure optimal results. Summary In this review, we characterize crucial aspects to consider when developing a center of excellence for prostate imaging and biopsy as well as insights regarding how to implement them. Keywords Multiparametric magnetic resonance image . Prostate . Biopsy . Fusion . Gleason . ISUP Introduction Multiparametric magnetic resonance imaging (mp-MRI) has changed the paradigm of how we diagnose and treat prostate cancer. Conventionally, the suspicion of this disease was based on an elevated prostate-specific antigen (PSA), abnor- mal digital rectal examination, and TRUS images, all known to have low sensitivity and specificity for cancer diagnosis. Consequently, a systematic 12-core TRUS-guided biopsy was indicated that sampled 6 main areas of the prostate (bilateral apex, base, and mid). This systematic, not image guided, and thus inherently random approach has shown to lead to under- detection of clinically significant prostate cancer and over- detection of indolent tumors [1–4]. During the past decade, mp-MRI has played an increasing role in more accurately depicting areas suspected to harbor cancer, allowing us to perform an image-directed biopsy of these regions of interest, thus increasing the diagnostic yield of the procedure [5]. These mp-MRI-guided biopsies can be performed using dif- ferent techniques: in bore, cognitive, or using mp-MRI-TRUS software fusion biopsy platforms that fuse the mp-MRI with real-time ultrasound. Furthermore, the role of this imaging technique has expanded beyond detection of cancer, including preoperative evaluation and staging of tumors as an aid in surgical planning, evaluation of extracapsular extension and seminal vesical invasion, and improved characterization of possible candidates for active surveillance and follow-up of these patients as well as an increasing role in both patients with elevated PSA and prior negative biopsy and in the eval- uation of biopsy-naïve patients [6–11, 12•]. Mp-MRI in addi- tion to a targeted biopsy approach has quickly gained This article is part of the Topical Collection on New Imaging Techniques * Annerleim Walton-Diaz annerleim@gmail.com 1 Urofusión, Santiago, Chile 2 Urology, Instituto Nacional del Cáncer Chile, Santiago, Chile 3 Universidad de Chile, Santiago, Chile 4 Radiology Complejo Hospitalario San José, Santiago, Chile 5 Urology Hospital San Juan de Dios, Santiago, Chile 6 Centro de Estudios Clínicos Bradford Hill, Santiago, Chile 7 Oncology, Clínica Universidad de los Andes, Santiago, Chile Current Urology Reports (2019) 20:59 https://doi.org/10.1007/s11934-019-0923-3