The value of MR/US fusion prostate biopsy platforms in prostate cancer detection, a systematic review.

BACAKGROUND - Despite limitations considering the presence, staging and aggressiveness of prostate cancer, systematic ultrasound (US) guided biopsies are still the golden standard in the diagnosis of prostate cancer. Recently, promising results have been published about targeted prostate biopsies using MR/US fusion platforms. Different platforms are FDA-registered and have, mostly subjective, strengths and weaknesses. To our knowledge, no systematic review exists that objectively compared prostate cancer detection rates between the different platforms available.

OBJECTIVE - To assess the value of the different MR/US fusion platforms in prostate cancer detection with platform guided targeted prostate biopsies compared to systematic biopsies and other ways of MR/US fusion (cognitive fusion or in-bore MR fusion), we reviewed well-designed prospective randomized and non-randomized trials.

DATA SOURCES - A systematic review of English articles published between January 1st, 2004 and February 17th, 2015 using PubMed, Embase and Cochrane Library databases was performed. Search terms included: prostate cancer, MR/ultrasound(US) fusion and targeted biopsies.

STUDY SELECTIONS - Extraction of articles was performed by two authors (M.G. and A.A.) and were evaluated by the other authors. Randomized and non-randomized prospective clinical trials comparing targeted prostate biopsies using a MR/US fusion platform and systematic randomized prostate biopsies or other ways of targeted prostate biopsies (cognitive fusion or MR in-bore fusion) were included.

DATA EXTRACTION METHODS AND DATA SYNTHESIS - 11 of 1865 studies met the inclusion criteria, involving seven different fusion platforms and 2626 subjects: 1119 biopsy naïve, 1433 with prior negative biopsy, 50 not mentioned (either biopsy naïve or with prior negative biopsy) and 24 on active surveillance (which were disregarded). The QUADAS-2 tool was used to assess the quality of included articles. No clear advantage of MR/US fusion guided-biopsies can be observed regarding cancer detection rates (CDRs) of all PCas. However, MR/US fusion guided-biopsies tend to give a higher CDR of clinically significant PCas in our analysis.

LIMITATIONS - Important limitations of this systematic review include the limited number of included studies, lack of a general definition of clinically significant prostate cancer, the heterogenous study population and a reference test with low sensitivity and specificity.

CONCLUSIONS - Today, a limited number of prospective studies have reported CDRs of fusion platforms. Although MR/US fusion targeted-biopsies has proved its value in men with prior negative biopsies, general use of this technique in diagnosis of prostate cancer should only be performed after critical consideration. Before bringing MR/US fusion guided biopsies in general practice, there is a need of more prospective studies in PCa diagnosis. This article is protected by copyright. All rights reserved.

BJU Int. 2015 Aug 3. doi: 10.1111/bju.13247. [Epub ahead of print]

Gayet M1,2, van der Aa A1,2, Beerlage HP1, Schrier BP1, Mulders PF3, Wijkstra H2,4.

1 Department of Urology, Jeroen Bosch Hospital, 's, Hertogenbosch, The Netherlands.
2 Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
3 Department of Urology, Radboudumc university hospital, Nijmegen, The Netherlands.
4 Department of Urology, AMC university hospital, Amsterdam, The Netherlands.