Meta-analysis: prostate MRI tops standard biopsy for cancer detection

  • Kasivisvanathan V & al.
  • Eur Urol
  • 23 May 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Meta-analysis suggests that in individuals with suspected prostate cancer, magnetic resonance imaging-targeted biopsy (MRI-TB) vs systematic biopsy:
    • Increases clinically significant cancer detection rate by 16%,
    • Avoids biopsies in 34% of individuals with clinically insignificant cancer, and
    • Requires fewer biopsy cores.

Why this matters

  • MRI-TB strategy can identify individuals who will benefit from treatment, avoid unnecessary biopsy, and overtreatment in low-risk disease.

Study design

  • Meta-analysis of 76 studies (including 8 randomized studies) and 14,709 individuals with suspected prostate cancer, identified after a search on PubMed, Embase, Web of Science, Cochrane library, and Clinicaltrials.gov databases.
  • Funding: United Kingdom National Institute for Health Research.

Key results

  • MRI-TB detected a higher number of patients with clinically significant cancer vs systematic biopsy (56 studies; detection ratio [DR], 1.16; P<.0001 and fewer with clinically insignificant cancer studies dr p>
  • The proportion of cores positive for cancer was significantly higher with MRI-TB vs systematic biopsy (18 studies; 31% vs 11%; relative risk, 3.17; P<.0001>
  • No difference was observed in any cancer detection (DR, 1.02; P=.49).

Limitations

  • Publication bias.

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