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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Although rhabdomyosarcoma is the most frequent soft tissue tumor in children, there are extremely few reports of this tumor arising from the urachus. The authors describe another case in a 6-year-old female associated with constipation and a painless suprapubic mass. The specimen had the pathological criteria used to define urachal sarcoma (cytological, histological, and immunohistochemical findings) and urachal remnants were not observed. After complete resection of the primary tumor the patient was treated with chemotherapy (ifosfamide, vincristine, and dactinomycin) and remains alive at 4 years' follow-up with no signs of recurrence. Nowadays the management of children with urachal rhabdomyosarcoma usually includes surgery and chemotherapy. Multimodal therapy and surgery are constantly evolving and have significantly improved overall survival of these patients especially in R0 resected patients.

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