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previous negative biopsy, and continued suspicion of prostate cancer, we are seeing an increased utilization on mpMRI in biopsy naive men. We performed a systematic review and meta-analysis of prospective studies looking at the performance of mpMRI on prostate cancer detection in men who had never undergone a previous biopsy of the prostate.METHODS: We searched the Pubmed, Embase and Cochrane databases for studies assessing the performance of mpMRI on prostate cancer detection at biopsy. Studies were included if they were prospective, included only patients with no previous prostate biopsy, and reported biopsy outcomes for all patients including those with a negative mpMRI. Each mpMRI was classified as either positive or negative for suspicion of prostate cancer. We used standard methods recommended for meta-analyses of diagnostic test evaluation and reported the pooled sensitivity, specificity, and positive and negative likelihood ratios for mpMRI on the detection of any and clinically significant prostate cancer (csPCa). csPCa was defined according to the definition used in each paper, which was usually any Gleason 7 or a minimum length of Gleason 6. Summary receiver operating characteristic (SROC) curves were used to assess the performance of mpMRI on prostate cancer detection.RESULTS: Ten studies met the inclusion criteria comprising 2,194 patients. If a biopsy was only to be performed in men with a positive mpMRI, then 7.4 to 58.5% of biopsies could have been avoided, with only 2.3-36% of cancers and 6.3-30.8% of csPCa being missed. Of the ten studies we found, nine had data available for a metaanalysis of any prostate cancer and five had data available for a metaanalysis of csPCa. For any prostate cancer, the pooled sensitivity and specificity were 0.83 (95% CI, 0.75-0.88), and 0.71 (0.46-87), while the positive and negative likelihood ratio were 2.9 (1.3-6.0) and 0.23 (0.15-0.35), respectively. The AUC for any prostate cancer detection was 0.87 and the diagnostic odds ratio (DOR) was 12.3 (4.3-34.7). For csPCa, the pooled sensitivity and specificity was 0.83 (0.75-0.88) and 0.58 (0.46e0.69), while, the positive and negative likelihood ratio was 2 (CI, 1.5-2.5), and 0.28 (0.19-0.39), respectively. The AUC for csPCa detection was 0.66 and the DOR was 7.1 (4.5-11.1).CONCLUSIONS: A meta-analysis of prospective studies in men with no previous biopsy of the prostate confirms that mpMRI of the prostate accurately detects prostate cancer and can help avoid unnecessary biopsies.

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IntroductionHumans are more familiar with index – thumb than with any other finger to thumb grasping. The effect of familiarity has been previously tested with complex, specialized and/or transitive movements, but not with simple intransitive ones. The aim of this study is to evaluate brain activity patterns during the observation of simple and intransitive finger movements with differing degrees of familiarity.MethodologyA functional Magnetic Resonance Imaging (fMRI) study was performed using a paradigm consisting of the observation of 4 videos showing a finger opposition task between the thumb and the other fingers (index, middle, ring and little) in a repetitive manner with a fixed frequency (1 Hz). This movement is considered as the pantomime of a precision grasping action.ResultsSignificant activity was identified in the bilateral Inferior Parietal Lobule and premotor regions with the selected level of significance (FDR [False Discovery Rate] = 0.01). The extent of the activation in both regions tended to decrease when the finger that performed the action was further from the thumb. More specifically, this effect showed a linear trend (index>middle>ring>little) in the right parietal and premotor regions.ConclusionsThe observation of less familiar simple intransitive movements produces less activation of parietal and premotor areas than familiar ones. The most important implication of this study is the identification of differences in brain activity during the observation of simple intransitive movements with different degrees of familiarity.