Presentation Authors: Xiang Tu*, Shi Qiu, He Xu, Yige Bao, Lu Yang, Qiang Wei, Chengdu, China, People's Republic of
Introduction: Clinical guidelines recommended performing multiparametric magnetic resonance imaging (mpMRI) and fusion targeting any mpMRI lesions in the repeat-biopsy setting. However, its role in biopsy-naÃ¯ve men remained controversial. We synthesized current evidence based on well-designed randomized controlled trials (RCTs) to investigate the role of prebiopsy mpMRI and MRI/TRUS fusion targeted biopsy (TB) for prostate cancer (PCa) diagnosis in biopsy-naÃ¯ve men.
Methods: A systematic review of PubMed (Medline), Embase, Ovid and the Cochrane Library up to 1st October 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The statistical analyses were performed with Revman 5.3. We compared the diagnostic accuracy between the intervention group (using prebiopsy mpMRI to select patients for TB) and the control group (standard biopsy regardless of MRI results) by calculating the risk ratio (RR) with 95% confidence intervals (CIs) of overall PCa and clinically significant PCa (csPCa) detection rates (DRs). Subgroup analysis was performed to highlight the independent role of SB and MRI/TRUS fusion TB by stratifying patients of different biopsy approach.
Results: Six RCTs with 2187 participants were evaluated. Pooled analysis revealed slight higher overall PCa DRs of 62.7% (687/1095) in the intervention group compared with that of 41.3% (451/1092) in the control group (RR 1.40, 95% CI: 1.00-1.95) [Figure 1]. And there was a trend favoring the use mpMRI before biopsy which detected more csPCa (42.8%, 206/481) compared with SB only in the control group (31.6%, 152/481) (RR 1.36, 95% CI: 0.95-1.95) [Figure 2]. Further analysis revealed positive prebiopsy mpMRI with MRI/fusion TB detected more csPCa (52.9%, 193/365) in the intervention group compared with SB only without any mpMRI in the control group (31.6%, 152/481) (RR 1.64, 95% CI 1.06-2.52) [Figure 3]. However, SB helped detect missed PCa for patients of negative mpMRI (23.5%, 20/85) and nearly half of the tumors were clinically significant.
Conclusions: The use of prebiopsy mpMRI may help improve overall PCa and csPCa DRs in biopsy-naÃ¯ve men. However, SB may play a role in detecting missed PCa for patients of negative mpMRI.