Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis.

Multiparametric magnetic resonance imaging (MRI) of the prostate may improve the diagnostic accuracy of prostate cancer detection in MRI-targeted biopsy (MRI-TBx) in comparison to transrectal ultrasound-guided biopsy (TRUS-Bx). Systematic review and meta-analysis of evidence regarding the diagnostic benefits of MRI-TBx versus TRUS-Bx in detection of overall prostate cancer (primary objective) and significant/insignificant prostate cancer (secondary objective). A systematic review of Embase, Medline, Web of Science, Scopus, PubMed, Cinahl, and the Cochrane library was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Identified reports were critically appraised according to the Quality Assessment of Diagnostic Accuracy Studies criteria. Only men with a positive MRI were included. The reports we included (16 studies) used both MRI-TBx and TRUS-Bx for prostate cancer detection. A cumulative total of 1926 men with positive MRI were included, with prostate cancer prevalence of 59%. MRI-TBx and TRUS-Bx did not significantly differ in overall prostate cancer detection (sensitivity 0.85, 95% confidence interval [CI] 0.80-0.89, and 0.81, 95% CI 0.70-0.88, respectively). MRI-TBx had a higher rate of detection of significant prostate cancer compared to TRUS-Bx (sensitivity 0.91, 95% CI 0.87-0.94 vs 0.76, 95% CI 0.64-0.84) and a lower rate of detection of insignificant prostate cancer (sensitivity 0.44, 95% CI 0.26-0.64 vs 0.83, 95% confidence interval 0.77-0.87). Subgroup analysis revealed an improvement in significant prostate cancer detection by MRI-TBx in men with previous negative biopsy, rather than in men with initial biopsy (relative sensitivity 1.54, 95% CI 1.05-2.57 vs 1.10, 95% CI 1.00-1.22). Because of underlying methodological flaws of MRI-TBx, the comparison of MRI-TBx and TRUS-Bx needs to be regarded with caution. In men with clinical suspicion of prostate cancer and a subsequent positive MRI, MRI-TBx and TRUS-Bx did not differ in overall prostate cancer detection. However, MRI-TBx had a higher rate of detection of significant prostate cancer and a lower rate of detection of insignificant prostate cancer compared with TRUS-Bx. We reviewed recent advances in magnetic resonance imaging (MRI) for guidance and targeting of prostate biopsy for prostate cancer detection. We found evidence to suggest that MRI-guided targeted biopsy benefits the diagnosis of prostate cancer.

Schoots IG ，Roobol MJ ，Nieboer D ，Bangma CH ，Steyerberg EW ，Hunink MG ... -  《-》

Comparison of prostate cancer detection rates between magnetic resonance imaging-targeted biopsy and transrectal ultrasound-guided biopsy according to Prostate Imaging Reporting and Data System in patients with PSA ≥4 ng/mL: a systematic review and meta-a

Previous studies have investigated magnetic resonance imaging-targeted biopsy (MRI-TBx) on the detection for prostate cancer (PCa). Prostate Imaging Reporting and Data System (PI-RADS), as a standardized MRI reporting system, has widely been used in the management of PCa. However, basing the PI-RADS score, the comparability between MRI-TBx and transrectal ultrasound-guided biopsy (TRUS-Bx) in diagnosing PCa remained inconsistent or even controversial. Thus, this systematic meta-analysis aimed to assess the value of PI-RADS in sifting better prostate biopsy method. A meta-analysis including 10 articles was performed. In these included studies, biopsy-naive subjects with concerning PSA levels and/or an abnormal digital rectal examination (DRE) were consecutively enrolled by referral from urologists. All subjects underwent multiparameter MRI (mpMRI) prostate and the results were scored independently by PI-RADS. Subjects with equivocal (PI-RADS 3) and intermediate/high-risk (PI-RADS 4/5) lesions underwent MRI-TBx and followed by TRUS-Bx performed by a urologist. The online databases PubMed, Embase and Web of Science were searched to find all correlated articles until October 1st, 2019. Data were pooled by odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the associations. Subgroup analyses were conducted based on Gleason score. Overall, 10 studies were included in this meta-analysis from January, 2015 to June, 2019. In the comparison of the detection of MRI-TBx and TRUS-Bx in PCa patients, TRUS-Bx had a significant advantage in overall PCa detection compared with MRI-TBx (OR =0.78, 95% CI: 0.62-0.98) in PI-RADS 3. Basing subgroup analysis of Gleason score (csPCa: Gleason score ≥7; non-csPCa: Gleason score <7), a summary analysis of the detection rate of csPCa showed that no significant difference was found (OR =0.82, 95% CI: 0.58-1.16); Meanwhile, no significant difference in non-csPCa patients was also detected (OR =0.83, 95% CI: 0.53-1.28). In PI-RADS 4 or 5, no significant results were detected between MRI-TBx and TRUS-Bx (OR =0.96, 95% CI: 0.87-1.06) for overall PCa detection. The stratification analyses by Gleason score found that TRUS-Bx had an advantage over MRI-TBx in non-csPCa patients (OR =0.76, 95% CI: 0.60-0.98); However, there was no significant difference in the detection rate of csPCa (OR =1.05, 95% CI: 0.93-1.20). This meta-analysis indicated that using TRUS-Bx was better than MRI-TBx for the diagnosis of PCa in PI-RADS 3; Besides, TRUS-Bx have an advantage over MRI-TBx in the detection for non-csPCa in PI-RADS 4 or 5. Therefore, PI-RADS could be used as a MRI evaluation system in the selection of prostate biopsy.

Zhu K ，Qin Z ，Xue J ，Miao C ，Tian Y ，Liu S ，Zhu S ，Gu Q ，Hou C ，Xu A ，Yang J ，Wang Z ... -  《-》

Comparison of Cancer Detection Rates Between TRUS-Guided Biopsy and MRI-Targeted Biopsy According to PSA Level in Biopsy-Naive Patients: A Propensity Score Matching Analysis.

The purpose of the study was to compare cancer detection rates between 12-core transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and multiparametric magnetic resonance imaging (mpMRI)-guided target prostate biopsy (MRI-TBx) according to prostate-specific antigen (PSA) level in biopsy-naive patients. A retrospective study was conducted in 2009 biopsy-naive patients with suspected prostate cancer (PSA ≤20 ng/mL). Patients underwent TRUS-Bx (n = 1786) or MRI-guided target prostate biopsy (MRI-TBx; n = 223) from September 2013 to March 2017 and were stratified according to each of 4 PSA cutoffs. MRI-TBx was performed on lesions with Prostate Imaging Reporting and Data System (PI-RADS) scores of 3 to 5 on mpMRI. Clinically significant prostate cancer (csPCa) was defined as Gleason ≥7. Propensity score matching was performed using the prebiopsy variables, which included age, PSA, prostate volume, and PSA density. Propensity score matching resulted in 222 patients in each group. There were significant differences between the TRUS-Bx and MRI-TBx groups in the overall detection rates of prostate cancer (41.4% vs. 55.4%; P = .003) and csPCa (30.1% vs. 42.8%; P = .005). However, across PSA cutoffs, MRI-TBx detected more prostate cancer than TRUS-Bx at PSA levels of 2.5 to <4 (29.5% vs. 56.6%; P < .001). The csPCa detection rates of TRUS-Bx and MRI-TBx did not differ significantly within the PSA cutoffs. There was a significantly higher detection rate of prostate cancer and csPCa in lesions with PI-RADS scores 4 and 5 than in those with a score of 3. Prebiopsy mpMRI and subsequent targeted biopsy had a higher detection rate than TRUS-Bx in patients with prostate cancer and csPCa.

Choi YH ，Kang MY ，Sung HH ，Jeon HG ，Chang Jeong B ，Seo SI ，Jeon SS ，Kim CK ，Park BK ，Lee HM ... -  《-》

Multiparametric MRI in detection and staging of prostate cancer.

Boesen L 《Danish Medical Journal》

Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique?

The introduction of magnetic resonance imaging-guided biopsies (MRI-GB) has changed the paradigm concerning prostate biopsies. Three techniques of MRI-GB are available: (1) in-bore MRI target biopsy (MRI-TB), (2) MRI-transrectal ultrasound fusion (FUS-TB), and (3) cognitive registration (COG-TB). To evaluate whether MRI-GB has increased detection rates of (clinically significant) prostate cancer (PCa) compared with transrectal ultrasound-guided biopsy (TRUS-GB) in patients at risk for PCa, and which technique of MRI-GB has the highest detection rate of (clinically significant) PCa. We performed a literature search in PubMed, Embase, and CENTRAL databases. Studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist and START recommendations. The initial search identified 2562 studies and 43 were included in the meta-analysis. Among the included studies 11 used MRI-TB, 17 used FUS-TB, 11 used COG-TB, and four used a combination of techniques. In 34 studies concurrent TRUS-GB was performed. There was no significant difference between MRI-GB (all techniques combined) and TRUS-GB for overall PCa detection (relative risk [RR] 0.97 [0.90-1.07]). MRI-GB had higher detection rates of clinically significant PCa (csPCa) compared with TRUS-GB (RR 1.16 [1.02-1.32]), and a lower yield of insignificant PCa (RR 0.47 [0.35-0.63]). There was a significant advantage (p = 0.02) of MRI-TB compared with COG-TB for overall PCa detection. For overall PCa detection there was no significant advantage of MRI-TB compared with FUS-TB (p=0.13), and neither for FUS-TB compared with COG-TB (p=0.11). For csPCa detection there was no significant advantage of any one technique of MRI-GB. The impact of lesion characteristics such as size and localisation could not be assessed. MRI-GB had similar overall PCa detection rates compared with TRUS-GB, increased rates of csPCa, and decreased rates of insignificant PCa. MRI-TB has a superior overall PCa detection compared with COG-TB. FUS-TB and MRI-TB appear to have similar detection rates. Head-to-head comparisons of MRI-GB techniques are limited and are needed to confirm our findings. Our review shows that magnetic resonance imaging-guided biopsy detects more clinically significant prostate cancer (PCa) and less insignificant PCa compared with systematic biopsy in men at risk for PCa.

Wegelin O ，van Melick HHE ，Hooft L ，Bosch JLHR ，Reitsma HB ，Barentsz JO ，Somford DM ... -  《-》