Magnetic Resonance Imaging-targeted Biopsy Versus Systematic Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-analysis.

Magnetic resonance imaging (MRI)-targeted prostate biopsy (MRI-TB) may be an alternative to systematic biopsy for diagnosing prostate cancer.

The primary aims of this systematic review and meta-analysis were to compare the detection rates of clinically significant and clinically insignificant cancer by MRI-TB with those by systematic biopsy in men undergoing prostate biopsy to identify prostate cancer.

A literature search was conducted using the PubMed, Embase, Web of Science, Cochrane library, and Clinicaltrials.gov databases. We included prospective and retrospective paired studies where the index test was MRI-TB and the comparator test was systematic biopsy. We also included randomised controlled trials (RCTs) if one arm included MRI-TB and another arm included systematic biopsy. The risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. In addition, the Cochrane risk of bias 2.0 tool was used for RCTs.

We included 68 studies with a paired design and eight RCTs, comprising a total of 14709 men who either received both MRI-TB and systematic biopsy, or were randomised to receive one of the tests. MRI-TB detected more men with clinically significant cancer than systematic biopsy (detection ratio [DR] 1.16 [95% confidence interval {CI} 1.09-1.24], p<0.0001) and fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57-0.76], p<0.0001). The proportion of cores positive for cancer was greater for MRI-TB than for systematic biopsy (relative risk 3.17 [95% CI 2.82-3.56], p<0.0001).

MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy.

We evaluated the published literature, comparing two methods of diagnosing prostate cancer. We found that biopsies targeted to suspicious areas on magnetic resonance imaging were better at detecting prostate cancer that needs to be treated and avoiding the diagnosis of disease that does not need treatment than the traditional systematic biopsy.

European urology. 2019 May 23 [Epub ahead of print]

Veeru Kasivisvanathan, Armando Stabile, Joana B Neves, Francesco Giganti, Massimo Valerio, Yaalini Shanmugabavan, Keiran D Clement, Debashis Sarkar, Yiannis Philippou, David Thurtle, Jonathan Deeks, Mark Emberton, Yemisi Takwoingi, Caroline M Moore

Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK. Electronic address: ., Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK., Division of Surgery and Interventional Science, University College, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Queen Elizabeth University Hospital, Glasgow, UK., British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Royal Hampshire County Hospital, Winchester, UK., British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Academic Urology Group, University of Cambridge, Cambridge, UK., Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre (University Hospital Birmingham NHS Foundation Trust and University of Birmingham), Birmingham, UK., Division of Surgery and Interventional Science, University College, London, UK; NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK., Division of Surgery and Interventional Science, University College, London, UK.

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