Review Article Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy Liam Toner 1 , Mahesha Weerakoon 1 , Damien M. Bolton 1 , 2 , Andrew Ryan 3 , Nikolas Katelaris 1 , Nathan Lawrentschuk 1 , 2, 4, * 1 University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia 2 Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia 3 Department of Pathology, TissuPath Specialist Pathology Services, Melbourne, Australia 4 Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia article info Article history: Received 13 March 2015 Accepted 31 March 2015 Available online 19 October 2015 Keywords: Diagnosis Histopathology Magnetic resonance imaging Prostate Prostatectomy Prostatic neoplasms abstract Purpose: Multiparametric magnetic resonance imaging (mpMRI) is an emerging technique aiming to improve upon the diagnostic sensitivity of prostate biopsy. Because of variance in interpretation and application of techniques, results may vary. There is likely a learning curve to establish consistent reporting of mpMRI. This study aims to review current literature supporting the diagnostic utility of mpMRI when compared with radical prostatectomy (RP) and template transperineal biopsy (TTPB) specimens. Methods: MEDLINE and PubMed database searches were conducted identifying relevant literature related to comparison of mpMRI with RP or TTPB histology. Results: Data suggest that compared with RP and TTPB specimens, the sensitivity of mpMRI for prostate cancer (PCa) detection is 80e90% and the specificity for suspicious lesions is between 50% and 90%. Conclusions: mpMRI has an increasing role for PCa diagnosis, staging, and directing management to- ward improving patient outcomes. Its sensitivity and specificity when compared with RP and TTPB specimens are less than what some expect, possibly reflecting a learning curve for the technique of mpMRI. Copyright © 2015 Asian Pacific Prostate Society, Published by Elsevier. All rights reserved. 1. Introduction Prostate cancer (PCa) is the second most common cause of cancer death in Australian men and is the most commonly diag- nosed internal malignancy with one in seven Australian men being diagnosed with PCa by the age of 75. 1 PCa may first present with elevated prostate-specific antigen (PSA) on screening or symp- tomatically with lower urinary tract symptoms, bony pain from metastases or uncommonly with hematuria, urinary retention, or renal failure. 2 The definitive diagnosis of PCa is generally made by a biopsy, typically transrectal ultrasound (TRUS)-guided biopsy. Staging is typically by a nuclear medicine bone scan or computed tomographyepositron emission tomography. 3 An influential work by McNeal et al in 1988 4 demonstrated trends in the zonal origin of PCa, particularly the predominance of malignancy within the peripheral zone (PZ) and hence its amena- bility to detection on digital rectal examination (DRE) and TRUS- guided biopsy. However, a minority of cancers arose from more anterior regions of the prostate leading to a newly articulated phenomenon “prostatic evasive anterior tumor syndrome (PEATS).” PEATS describes a subset of PCa which, due to anatomical location, may be missed by traditional investigations such as DRE and TRUS biopsy, both of which primarily focus on the PZ, but may be detected by multiparametric magnetic resonance imaging (mpMRI) or transperineal biopsy (TPB). 5 Management of PCa depends on risk stratification, most commonly the Gleason score, TNM staging, and PSA level. Lower risk cancers may be indolent and require active surveillance (AS) involving (with local variation) monitoring PSA levels (serial PSA tests), DREs, biopsy, and possibly mpMRI or watchful waiting for * Corresponding author. Urology Research Office, Level 8 Harold Stokes Building, Austin Hospital, 145 Studley Road, Heidelberg VIC 3084, Australia. E-mail address: lawrentschuk@gmail.com (N. Lawrentschuk). Contents lists available at ScienceDirect Prostate International journal homepage: http://p-international.org. http://dx.doi.org/10.1016/j.prnil.2015.09.006 p2287-8882 e2287-903X/Copyright © 2015 Asian Pacific Prostate Society, Published by Elsevier. All rights reserved. Prostate Int 3 (2015) 107e114