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Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer: a systematic review and meta-analysis

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Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer : a systematic review and meta-analysis. / Elwenspoek, Martha M.C.; Sheppard, Athena L.; McInnes, Matthew D.F.; Merriel, Samuel W.D.; Rowe, Edward W.J.; Bryant, Richard J.; Donovan, Jenny L.; Whiting, Penny.

In: JAMA Network Open, Vol. 2, No. 8, e198427, 07.08.2019.

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@article{a6e030b5f8fd4591ae72725a6944c0a8,
title = "Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer: a systematic review and meta-analysis",
abstract = "Importance: 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.Objective: 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.Data Sources: 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”.Study Selection: RCTs comparing diagnostic pathways including pre-biopsy MRI versus systematic TRUS-guided biopsy in biopsy-na{\"i}ve 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.Results: 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.",
author = "Elwenspoek, {Martha M.C.} and Sheppard, {Athena L.} and McInnes, {Matthew D.F.} and Merriel, {Samuel W.D.} and Rowe, {Edward W.J.} and Bryant, {Richard J.} and Donovan, {Jenny L.} and Penny Whiting",
year = "2019",
month = "8",
day = "7",
doi = "10.1001/jamanetworkopen.2019.8427",
language = "English",
volume = "2",
journal = "JAMA Network Open",
issn = "2574-3805",
publisher = "American Medical Association",
number = "8",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer

T2 - a systematic review and meta-analysis

AU - Elwenspoek, Martha M.C.

AU - Sheppard, Athena L.

AU - McInnes, Matthew D.F.

AU - Merriel, Samuel W.D.

AU - Rowe, Edward W.J.

AU - Bryant, Richard J.

AU - Donovan, Jenny L.

AU - Whiting, Penny

PY - 2019/8/7

Y1 - 2019/8/7

N2 - Importance: 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.Objective: 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.Data Sources: 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”.Study Selection: 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.Results: 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.

AB - Importance: 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.Objective: 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.Data Sources: 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”.Study Selection: 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.Results: 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.

UR - http://www.scopus.com/inward/record.url?scp=85070567358&partnerID=8YFLogxK

U2 - 10.1001/jamanetworkopen.2019.8427

DO - 10.1001/jamanetworkopen.2019.8427

M3 - Article

C2 - 31390032

AN - SCOPUS:85070567358

VL - 2

JO - JAMA Network Open

JF - JAMA Network Open

SN - 2574-3805

IS - 8

M1 - e198427

ER -