Advertisement

Performance of Multiparametric MRI of the Prostate in Biopsy Naïve Men: A Meta-analysis of Prospective Studies

Published:September 01, 2020DOI:https://doi.org/10.1016/j.urology.2020.06.102

      Abstract

      OBJECTIVE

      To assess the outcomes through systematic review and meta-analysis of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in biopsy naïve men.

      METHODS

      Systemic review and meta-analysis was performed to assess the performance of mpMRI on prostate cancer (PCa) detection at the time of biopsy. We used standard methods for performing a meta-analysis evaluating a diagnostic test and reported the pooled sensitivity and specificity, and the positive and negative likelihood ratios (LR) for mpMRI in the detection of any and clinically significant prostate cancer (csPCa).

      RESULTS

      A total of 10 studies comprising 2486 patients were analyzed. Overall, if biopsies would have been performed only in men with an mpMRI suspicious for malignancy between 7.4% and 58.5% of the biopsies could have been avoided, but 2.3%-36% of any PCa and 0%-30.8% of csPCa would have been missed. The sensitivity, specificity, positive LR, and negative LR of mpMRI for any PCa detection were 0.86 (95% confidence interval [CI], 0.78-0.91), 0.67 (95% CI, 0.40-0.86), 2.6 (95% CI, 1.2-5.5), and 0.2 (95% CI, 0.12-0.32), respectively. The AUC for any PCa detection was 0.84 (95% CI, 0.75-0.90). The pooled sensitivity, specificity, positive LR, and negative LR of mpMRI for csPCa detection was 0.94 (95% CI, 0.83-0.98), 0.54 (95% CI, 0.42-0.65), 2 (95% CI, 1.5-2.7), and 0.1 (95% CI, 0.02-0.35), respectively. The AUC for csPCa detection was 0.94 (95% CI, 0.65-1).

      CONCLUSION

      This study provides summary estimates indicating that mpMRI can accurately detect prostate cancer and help avoid unnecessary biopsies in this population
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2017.
        CA Cancer J Clin. 2017; 67: 7-30
        • Mottet N
        • Bellmunt J
        • Bolla M
        • et al.
        EAU-ESTRO-SIOG guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent.
        Eur Urol. 2017; 71: 618-629
        • Loeb S
        • Carter HB
        • Berndt SI
        • Ricker W
        • Schaeffer EM
        Complications after prostate biopsy: data from SEER-Medicare.
        J Urol. 2011; 186: 1830-1834
        • Sharp L
        • Morgan E
        • Drummond FJ
        • Gavin A
        The psychological impact of prostate biopsy: prevalence and predictors of procedure-related distress.
        Psycho-oncology. 2017;
        • Schroder FH
        • Hugosson J
        • Roobol MJ
        • et al.
        Prostate-cancer mortality at 11 years of follow-up.
        N Engl J Med. 2012; 366: 981-990
        • Hamoen EH
        • de Rooij M
        • Witjes JA
        • Barentsz JO
        • Rovers MM
        Use of the prostate imaging reporting and data system (PI-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis.
        Eur Urol. 2015; 67: 1112-1121
        • Bjurlin MA
        • Rosenkrantz AB
        • Taneja SS
        Role of MRI prebiopsy in men at risk for prostate cancer: taking off the blindfold.
        Curr Opin Urol. 2017; 27: 246-253
        • Rosenkrantz AB
        • Verma S
        • Choyke P
        • et al.
        Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR.
        J Urol. 2016; 196: 1613-1618
        • Abdi H
        • Zargar H
        • Goldenberg SL
        • et al.
        Multiparametric magnetic resonance imaging-targeted biopsy for the detection of prostate cancer in patients with prior negative biopsy results.
        Urol Oncol. 2015; 33 (e1-7): 165
        • Ahmed HU
        • El-Shater Bosaily A
        • Brown LC
        • et al.
        Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.
        Lancet (London, England). 2017; 389: 815-822
        • Tonttila PP
        • Lantto J
        • Paakko E
        • et al.
        Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: results from a randomized prospective blinded controlled trial.
        Eur Urol. 2016; 69: 419-425
        • Moldovan PC
        • Van den Broeck T
        • Sylvester R
        • et al.
        What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? a systematic review and meta-analysis from the European association of urology prostate cancer guidelines panel.
        Eur Urol. 2017;
        • Futterer JJ
        • Briganti A
        • De Visschere P
        • et al.
        Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature.
        Eur Urol. 2015; 68: 1045-1053
        • Gardner IA
        • Greiner M
        Receiver-operating characteristic curves and likelihood ratios: improvements over traditional methods for the evaluation and application of veterinary clinical pathology tests.
        Vet Clin Path. 2006; 35: 8-17
        • Porpiglia F
        • Manfredi M
        • Mele F
        • et al.
        Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a randomized prospective study in biopsy-naïve patients with suspected prostate cancer.
        Eur Urol. 2017; 72: 282-288
        • Baco E
        • Rud E
        • Eri LM
        • et al.
        A randomized controlled trial to assess and compare the outcomes of two-core prostate biopsy guided by fused magnetic resonance and transrectal ultrasound images and traditional 12-core systematic biopsy.
        Eur Urol. 2016; 69: 149-156
        • Stanzione A
        • Imbriaco M
        • Cocozza S
        • et al.
        Biparametric 3T magentic resonance imaging for prostatic cancer detection in a biopsy-naive patient population: a further improvement of PI-RADS v2?.
        Eur J Radiol. 2016; 85: 2269-2274
        • Thompson JE
        • van Leeuwen PJ
        • Moses D
        • et al.
        The diagnostic performance of multiparametric magnetic resonance imaging to detect significant prostate cancer.
        J Urol. 2016; 195: 1428-1435
        • Hauth E
        • Hohmuth H
        • Cozub-Poetica C
        • Bernand S
        • Beer M
        • Jaeger H
        Multiparametric MRI of the prostate with three functional techniques in patients with PSA elevation before initial TRUS-guided biopsy.
        Br J Radiol. 2015; 8820150422
        • Panebianco V
        • Barchetti F
        • Sciarra A
        • et al.
        Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study.
        Urol Oncol. 2015; 33 (e1-e7): 17
        • Pokorny MR
        • de Rooij M
        • Duncan E
        • et al.
        Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies.
        Eur Urol. 2014; 66: 22-29
        • Numao N
        • Yoshida S
        • Komai Y
        • et al.
        Usefulness of pre-biopsy multiparametric magnetic resonance imaging and clinical variables to reduce initial prostate biopsy in men with suspected clinically localized prostate cancer.
        J Urol. 2013; 190: 502-508
        • De Rooij M
        • Hamoen EHJ
        • Fütterer JJ
        • Barentsz JO
        • Rovers MM
        Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis.
        Am J Roentgenol. 2014; 202: 343-351
        • Vickers A
        • Carlsson SV
        • Cooperberg M
        Routine use of magnetic resonance imaging for early detection of prostate cancer is not justified by the clinical trial evidence.
        Eur Urol. 2020;
        • Eichler K
        • Hempel S
        • Wilby J
        • Myers L
        • Bachmann LM
        • Kleijnen J
        Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review.
        J Urol. 2006; 175: 1605-1612