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Editorial Comment Editorial Comment to Magnetic resonance spectroscopy imaging-directed transrectal ultrasound biopsy increases prostate cancer detection in men with prostate-specific antigen between 4–10 ng/mL and normal digital rectal examination In the current issue of International Journal of Urology, Javali et al. found that magnetic resonance spectroscopy imaging (MRSI)-directed transrectal ultrasound (TRUS) biopsy increases the cancer detection rate compared with standard TRUS biopsy. 1 This interesting study confirms the findings of numerous papers regarding the potential usefulness of magnetic resonance imaging (MRI) for the diagnosis of prostate cancer. However, readers should consider several others findings when interpreting these results. Unfortunately, as acknowledged by the authors, the positive predictive value (PPV) was much lower (24.4%), and the final radical prostatectomy (RP) specimens were not available for comparison. In fact, 90 of 140 patients in the present study had suspected prebiopsy MRSI, and finally just 22 of them had prostate cancer (24.4%). Concordantly, Perdona et al. found in prospective analysis that the PPV of 1.5 Tesla MRSI and dynamic contrast enhanced-MRI was unsatis- factorily low as a result of the high number of false positives (chronic prostatitis). 2 Compared to 1.5 Tesla, the 3 Tesla-MRI (3T-MRI) improves the positive predictive value of MRI for detection of prostate cancer. For example, Ferda et al. found in a recent prospective study of 161 patients that 3T-MRI detected prostate cancer with a sensitivity of 97.6%, specificity of 85.0%, PPV of 74.6% and negative predictive value of 96.3%. 3 TD JAVALI ET AL. 262 © 2013 The Japanese Urological Association