MRI-targeted biopsy yields a superior prostate cancer detection rate

  • Goldberg H & al.
  • J Urol
  • 1 Jun 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Biopsy-naive men with suspected prostate cancer who underwent a multiparametric (mp) MRI-targeted biopsy with or without systematic biopsy had a significantly higher detection rate of any-grade, clinically meaningful, and high-grade cancer vs systematic biopsy alone.
  • Performing only targeted biopsies lowered the rate of clinically insignificant cancer diagnosis, but not of clinically meaningful or high-grade cancer.

Why this matters

  • Recent guidelines recommend performing mpMRI in biopsy-naive men with suspected prostate cancer, but these recommendations are not widely used.

Study design

  • Meta-analysis of 29 studies including 13,845 biopsy-naive men with suspected prostate cancer.
  • 5 randomized clinical trials, 14 prospective cohort studies, and 10 retrospective studies were included.
  • Funding: UK National Institute for Health Research.

Key results

  • Compared with systematic biopsy, use of mpMRI-targeted biopsy was associated with:
    • 15% higher rate of any prostate cancer diagnosis (P<.00001>
    • 11% higher rate of clinically significant prostate cancer in 5 randomized trials (P=.05) and 18% higher in 9 prospective cohort studies (P<.00001>
    • 2% higher rate of high-grade cancer (P=.005).
    • No difference in diagnosis of clinically insignificant prostate cancer (risk difference, 0; P=.96).
  • The exclusion of systematic biopsy in the mpMRI informed targeted biopsy group was associated with a 5% lower rate of clinically insignificant cancer (P=.01), but no difference in any-grade, clinically significant, or high-grade cancer.

Limitations

  • The mpMRI informed biopsy procedure was not standardized.