Prostate cancer: magnetic resonance imaging-targeted biopsy vs systematic biopsy

Takeaway

• In men with a clinical suspicion of prostate cancer, magnetic resonance imaging-targeted biopsy (MRI-TB) detects more clinically significant cancer and less clinically insignificant cancer and requires fewer biopsy cores compared with systematic biopsy.
• MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy for the diagnosis of prostate cancer.

Why this matters

• MRI may be used to guide prostate biopsy cores to suspicious areas in the prostate.
• In men with raised prostate-specific antigen, the traditional systematic biopsy with 10–12-core transrectal ultrasound (TRUS)-guided biopsy has been challenged by evidence from systematic reviews and randomised controlled trials (RCTs).

Study design

• 76 studies (68 with a paired design and 8 RCTs) included 14,709 men, who met eligibility criteria, either received both MRI-TB and systematic biopsy or were randomly assigned to receive one of the tests.
• Funding: None disclosed.

Key results

• Pooled results of studies with paired-design showed that MRI-TB vs systematic biopsy detected more men with clinically significant cancer (detection ratio [DR], 1.16; 95% CI, 1.09-1.24) and fewer men with clinically insignificant cancer (DR, 0.66; 95% CI, 0.57-0.76; P<.0001 for both).
• MRI-TB plus TRUS biopsy detected men with clinically significant cancer vs systematic biopsy alone (5 RCTs; DR, 1.21; 95% CI, 0.94-1.57), but the difference was not significant (P=.14).
• MRI-TB plus TRUS biopsy vs TRUS biopsy alone did not differ in clinically insignificant cancer detection rates (4 RCTs; DR, 1.11, 95% CI, 0.49-2.51; P=.80).
• The proportion of cores positive for cancer was greater for MRI-TB vs systematic biopsy (relative risk [RR], 3.17; 95% CI, 2.82-3.56; P<.0001).

Limitations

• Risk of bias.
• Substantial between-study variability.