Prostate Magnetic Resonance Imaging, with or Without Magnetic Resonance Imaging-targeted Biopsy, and Systematic Biopsy for Detecting Prostate Cancer: A Cochrane Systematic Review and Meta-analysis

Abstract

Context: Magnetic resonance imaging (MRI), with or without MRI-targeted biopsy (MRI pathway), is an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of having prostate cancer. At present, evidence on which test to use is insufficient to inform detailed evidence-based decision making. Objective: To determine the diagnostic accuracy of the index tests MRI only, MRItargeted biopsy, MRI pathway, and systematic biopsy, as compared with templateguided biopsy (reference standard), in detecting clinically significant prostate cancer, defined as International Society of Urological Pathology grade 2 or higher, in biopsynaive men or those with a prior-negative biopsy (or mix of both). Evidence acquisition: We systematically searched the literature and considered for inclusion any cross-sectional study if it investigated (1) one or more index tests verified by the reference standard, and ( 2) paired testing of the MRI pathway with systematic biopsy. Quality and certainty of evidence were assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation, respectively. Evidence synthesis: Accuracy analyses: Using a baseline cancer prevalence of 30%, MRI pathway (sensitivity 0.72 [95% confidence interval {CI}: 0.60-0.82]; specificity 0.96 [0.94-0.98]; eight studies) may result in 216 (180-246) true positives, 28 (14-42) false positives, 672 (658-686) true negatives, and 84 (54-120) false negatives per 1000 men. Systematic biopsy (sensitivity 0.

A Novel Gene Signature-Based Model Predicts Biochemical Recurrence-Free Survival in Prostate Cancer Patients after Radical Prostatectomy

“…Another issue related to the salvage approach is the unclear definition of BCR which should trigger initiation of salvage radiotherapy. Its PSA-value threshold varied from 0.05 to 0.5 in different clinical trials and guidelines [26]. Taken together, optimally, postoperative radiotherapy should be performed in patients who suffer, albeit with possible low PSA values, or in those who are developing BCR with an unmeasurable PSA value at the initiation of radiotherapy.…”

Combined Use of Prostate-specific Antigen Density and Magnetic Resonance Imaging for Prostate Biopsy Decision Planning: A Retrospective Multi-institutional Study Using the Prostate Magnetic Resonance Imaging Outcome Database (PROMOD)

“…While several risk calculators and biomarkers have been developed and are currently under evaluation [2][3][4], the "MRI pathway" is supported by level 1 evidence, but seems to be limited by the low to moderate inter-reader and -center reproducibility and the low specificity/positive predictive value (PPV) [5][6][7]. Studies have shown that omitting biopsies in patients with no lesion on MRI would miss up to 5-11% of all csPCa cases (ISUP grade >2) [5,8], whereas performing biopsy in all patients with an equivocal MRI finding (PI-RADS 3 lesions considered to be positive by guidelines [9]) can result in a diagnosis of csPCa in 3-50% of the patients [5,8,10,11]. In this scenario, prostate-specific antigen (PSA) density (PSAd) is one of the strongest predictors of csPCa in risk models, and several studies found that PSAd and prostate MRI suspicion score, such as the PI-RADS score or Likert score, were significant independent predictors of csPCa at biopsy [12][13][14].…”

MRT-(inbore)-Biopsie zur sicheren Detektion kleiner oder ungünstig gelegener Prostatakarzinome bei negativer MRT/Ultraschall-Fusionsbiopsie

“…Dies zieht eine Übertherapie nach sich. Die qualitative multiparametrische MRT mit anschließender MR-gestützter Biopsie ist der TRUS-Biopsie diesbezüglich deutlich überlegen [1]. Dies gilt insbesondere bei anterior, apikal und lateral gelegenen Tumoren.…”