Biparametric versus Multiparametric Prostate MRI for the Detection of Prostate Cancer in Treatment-Naive Patients: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis - Beyond the Abstract

Prostate cancer is the second most common cancer affecting men worldwide. While prostate biopsies remain the ‘gold standard’ for confirming the diagnosis of cancer, prostate MRI has emerged as a valuable tool for the diagnosis and local staging of prostate cancer.

Prostate MRI is most commonly performed with the utilization of intravenous gadolinium contrast and is referred to as multiparametric MRI (mpMRI).  This involves T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) sequences. However, the DCE sequence has a relatively minor role to play in treatment-naïve patients. It is a useful adjunct particularly if the DWI or T2WI sequences are technically inadequate. On the other hand, the downside of gadolinium utilization includes the increased imaging costs and prolonged scan time, as well as the potential associated risk of allergic reactions.

On the other hand, parametric MRI (bpMRI) involves T2WI and DWI, without the utilization of DCE imaging. Multiparametric and bi-parametric prostate MRI have demonstrated similar diagnostic accuracy in detecting prostate cancer in treatment-naïve patients according to our new systematic review and meta-analysis.

Our team from McMaster University in Hamilton, Ontario, Canada, analyzed data from 31 studies, reporting on 9480 treatment-naïve men, of whom 4296 had prostate cancer. The pooled data revealed no significant difference between bpMRI and mpMRI in sensitivity (90% vs 86%) or specificity (70% vs 73%). These findings have been published in the BJU International Journal.

These findings are significant, as potentially, bpMRI may serve as a faster, relatively cheaper, contrast-free alternative to mpMRI in treatment-naïve patients. One possible scenario would involve a baseline mpMRI followed by bpMRI for follow-up and active surveillance. Additionally, if prostate cancer screening with MRI becomes more widely accepted, bpMRI can serve as a valuable tool, in place of mpMRI.

Written by: Abdullah Alabousi, Assistant Professor, McMaster University, Associate Staff, St. Joseph’s Healthcare Hamilton, St. Joseph's Healthcare, Department of Radiology, Hamilton, ON, Canada.

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