Multiparametric MRI localizes cancer in the prostate, allowing for MRI guided biopsy (MRI-GB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRI-GB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and MRI 'in-bore' biopsy (IB-TB). It is unknown whether any of these are superior. We conducted a systematic review and meta-analysis to address three questions. First, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Second, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Third, whether any MRI-GB strategy is superior at detecting csPCa.
A systematic literature review from 2015 to 2019 was performed in accordance with the START recommendations. Studies reporting PCa detection rates, employing MRI-GB and TRUS-GB were included and evaluated using the QUADAS-2 checklist. 1553 studies were found, of which 43 were included in the meta-analysis.
For csPCa, MRI-GB was superior in detection to TRUS-GB (0.83 vs. 0.63 [p = 0.02]). MRI-GB was superior in detection to TRUS-GB at avoiding detection of insignificant PCa. No MRI-GB technique was superior at detecting csPCa (IB-TB 0.87; COG TB 0.81; FUS-TB 0.81, [p = 0.55]). There was significant heterogeneity observed between the included studies.
In patients with suspected PCa on MRI, MRI-GB offers superior rates of csPCa detection and reduces detection of insignificant PCa compared to TRUS-GB. No individual MRI-GB technique was found to be better in csPCa detection. Prospective adequately powered randomized controlled trials are required.
Prostate cancer and prostatic diseases. 2021 Sep 21 [Epub ahead of print]
E J Bass, A Pantovic, M J Connor, S Loeb, A R Rastinehad, M Winkler, Rhian Gabe, H U Ahmed
Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. ., Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research -, Belgrade, Serbia., Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK., Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA., Department of Urology, Lenox Hill Hospital at Northwell Health, New York, NY, USA., Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.