Introduction: Accurate assessment of tumor aggressiveness plays a crucial role in the AS population. The current model to achieve this goal (sampling both index lesions with the systematic prostate template) often results in a large number of cores without reducing the diagnosis of clinically insignificant lesions. So, we aim to interpose the accuracy of prostate cancer (PCa) upgrading by multiparametric magnetic resonance image target-biopsy and systematic biopsy (SB) and also compare the results with the combined method - CB (MRI-TB plus SB) during AS.
Methods: We searched Medline, Embase, Cochrane CENTRAL, Web of Science, Scopus and LILACS were searched up to July 2019 for single-arm comparative studies; retrospective/prospective paired cohort, and randomized clinical trials (RCT) with paired comparisons. Using the PICOS method, the target population was those low-risk PCa cases in AS with at least one index lesion on mpMRI (PIRADS 3-5). The primary outcome was the upgrading to clinically significant PCa rate. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) score was applied to evaluate the quality of evidence. The AUC difference significance of both groups (SROC curves) was calculated in a two-tailed method. Finally, the positive predictive value (PPV) of the best single method (TB-MRI or SB) as well as of the CB were calculated and compared.
Results: Seven studies with 814 patients were included in the metanalysis. The pooled sensitivity for MRI-TB and SB groups was 0.79 (95% CI, 0.74-0.83; I²=75%, P=.001) and 0.67 (95% CI, 0.65-0.70; I² = 80.5%, P< .001), respectively. The AUC for TB and SB groups was 0.99 x 0.919 (P<.001). In regard PPV, the TB-MRI and CB groups presented the same PPV 98.3% (DR 36.9% x 44.5%; +LR 98.781 x 73.01; respectively).
Conclusions: Evidence suggests that patients with low-risk PCa on AS could undergo only to MRI-TB with results similar to CB in terms of tumor upgrade. This shift would be associated with fewer biopsy cores during the follow-up. Source of