Magnetic Resonance Imaging-targeted Biopsy Versus Systematic Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-Analysis – Beyond the Abstract

Multiparametric MRI (mpMRI) has significantly impacted on the diagnostic pathway of prostate cancer.1 Recent NICE (The National Institute for Health and Care Excellence)2 and EAU (European Association of Urology)3 guidelines now advocate pre-biopsy mpMRI in the assessment and diagnosis of suspected prostate cancer irrespective of previous biopsy status.

Utilising a collaborative research model through the BURST collaborative (British Urology Researchers in Surgical Training), we performed a systematic review and meta-analysis of the literature comparing the detection rates of clinically significant and clinically insignificant cancer (as defined by individual study authors) by MRI-targeted prostate biopsy (MRI-TB) with those by systematic biopsy in men undergoing prostate biopsy to identify prostate cancer.4

We included data from 68 studies with a paired design (men undergoing both MRI-TB and systematic biopsy) and eight randomized controlled trials (RCTs), comprising a total of 14,709 men. The results were reported according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines, and the risk of bias and assessment of quality was determined using a modified Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist and the Cochrane risk of bias tool 2.0 for RCTs.

In 56 studies (including 4 RCTs) comprising 4652 patients, 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; Fig 1). This effect was also seen when more strict definitions of clinically significant cancer were used in studies (Gleason 3+4 or greater; DR 1.09 [95% CI 1.02 – 1.18], Gleason 4=3 or greater; DR 1.38 [95% CI 1.14 – 1.68]).

In 46 studies including 2124 patients, MRI-TB detected fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57-0.76], p <0.0001; Fig 2). This effect was also evident in the sensitivity analysis defining clinically insignificant cancer as Gleason 3+3 (DR 0.74 [95% CI 0.65-0.84], p <0.0001).

In 18 studies comprising 2045 patients, the proportion of cores positive for cancer was 2464/7866 (31%) for MRI-TB and 3943/35873 (11%) for systematic biopsy (relative risk 3.17 [95% CI 2.82-3.56], p <0.0001).

To conclude, MRI-TB of the prostate improves the detection of clinically significant prostate cancer, reduces the detection of clinically insignificant prostate cancer, and has a higher yield of positive cores compared to systematic biopsy.

Written by: Keiran David Clement BScMedSci MBChB MRCS 1,2 and Veeru Kasivisvanathan MBBS BSc MRCS MSc PGCert 2,3

  1. Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
  2. British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK
  3. Division of Surgery and Interventional Science, University College, London, UK

References:

  1. Ahmed HU, El-Shater Bosaily A, Brown LC et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389: 815-22.
  2. National Institute for Health and Care Excellence (2019) Prostate Cancer: Diagnosis and Management(NICE Guideline 131). Available at: https://www.nice.org.uk/guidance/NG131 [Accessed 08/06/2019].
  3. Mottet N, Bellmunt J, Briers E, Bolla M, Bourke L, Cornford P., De Santis M., Henry A., Joniau S., Lam T., Mason M.D., Van den Poel H., Van den Kwast T.H., Rouvière O., Wiegel T.; members of the EAU – ESTRO – ESUR –SIOG Prostate Cancer Guidelines Panel. EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelone 2019. 978-94-92671-04-2. Publisher: EAU Guidelines Office. Place published: Arnhem, The Netherlands.
  4. Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis. Kasivisvanathan V, Stabile A, Neves JB, Giganti F, Valerio M, Shanmugabavan Y, Clement KD, Sarkar D, Philippou Y, Thurtle D, Deeks J, Emberton M, Takwoingi Y, Moore CM. Eur Urol. 2019 May: Epub ahead of print
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