The current diagnostic pathway for prostate cancer (PCa) in patients in whom there is a suspicion of this malignancy includes prostate biopsy. A large proportion of biopsied individuals have either no PCa or low-risk disease that does not require treatment. Unnecessary biopsies may potentially be avoided with pre-biopsy imaging.
To compare the performance of systematic trans-rectal ultrasound (TRUS) guided prostate biopsy versus pre-biopsy bi- or multi-parametric MRI followed by targeted +/- systematic biopsy.
Medline, Embase, Cochrane, Web of Science, clinical trial registries and reference lists of recent reviews were searched to December 2018 for randomized controlled trials (RCTs) using the terms “prostate cancer”, “MRI”.
RCTs comparing diagnostic pathways including pre-biopsy MRI versus systematic TRUS-guided biopsy in biopsy-naïve men with a clinical suspicion of PCa.
Data Extraction and Synthesis:
Data were pooled using random-effect meta-analysis. Risk of bias was assessed using the revised Cochrane tool. PRISMA guidelines were followed. All review stages were conducted by two reviewers.
Main Outcome(s) and Measure(s):
Detection rate of clinically significant and insignificant PCa, number of biopsy procedures, number of biopsy cores taken, and complications.
Seven high quality trials (2582 patients) were included. Compared against systematic TRUS biopsy alone, MRI +/- targeted biopsy was associated with an improved detection of clinically significant PCa of 57% (95% confidence interval (CI): 2-141%), a 33% potential reduction in the number of biopsy procedures (95% CI: 23-45%), and a 77% reduction in the number of cores taken per procedure (95% CI: 60-93%). One trial showed reduced pain and bleeding side-effects. Systematical sampling of the prostate in addition to the acquisition of targeted cores did not significantly improve detection of clinically significant PCa compared to systematic biopsy alone.
Conclusions and Relevance:
Pre-biopsy MRI combined with targeted biopsy was superior to systematic TRUS biopsy alone in detecting clinically significant PCa, despite substantial heterogeneity between trials. It was associated with a reduced number of individual biopsy cores taken per procedure, and with reduced side effects, and potentially prevents unnecessary biopsies in some individuals. This evidence supports implementation of pre-biopsy MRI into diagnostic pathways for suspected PCa.
- Centre for Surgical Research
- Bristol Medical School (PHS) - Associate Professor in Clinical Epidemiology
- Bristol Population Health Science Institute
- NIHR Applied Research Collaboration West (NIHR ARC West)
Person: Academic , Member