Comparison of magnetic resonance imaging-stratified clinical pathways and systematic transrectal ultrasound-guided biopsy pathway for the detection of clinically significant prostate cancer: A systematic review and meta-analysis of randomized controlled trials Review

   

Authors:	Woo, S.; Suh, C. H.; Eastham, J. A.; Zelefsky, M. J.; Morris, M. J.; Abida, W.; Scher, H. I.; Sidlow, R.; Becker, A. S.; Wibmer, A. G.; Hricak, H.; Vargas, H. A.
Review Title:	Comparison of magnetic resonance imaging-stratified clinical pathways and systematic transrectal ultrasound-guided biopsy pathway for the detection of clinically significant prostate cancer: A systematic review and meta-analysis of randomized controlled trials
Abstract:	CONTEXT: Recent studies suggested that magnetic resonance imaging (MRI) followed by targeted biopsy ("MRI-stratified pathway") detects more clinically significant prostate cancers (csPCa) than the systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx) pathway, but controversy persists. Several randomized clinical trials (RCTs) were recently published, enabling generation of higher-level evidence to evaluate this hypothesis. OBJECTIVE: To perform a systematic review and meta-analysis of RCTs comparing the detection rates of csPCa in the MRI-stratified pathway and the systematic TRUS-Bx pathway in patients with a suspicion of prostate cancer (PCa). EVIDENCE ACQUISITION: PubMed, EMBASE, and Cochrane databases were searched up to March 18, 2019. RCTs reporting csPCa detection rates of both pathways in patients with a clinical suspicion of prostate cancer were included. Relative csPCa detection rates of the MRI-stratified pathway were pooled using random-effect model. Study quality was assessed using the Cochrane risk of bias tool for randomized trials. A comparison of detection rates of clinically insignificant PCa (cisPCa) and any PCa was also performed. EVIDENCE SYNTHESIS: Nine RCTs (2908 patients) were included. The MRI-stratified pathway detected more csPCa than the TRUS-Bx pathway (relative detection rate 1.45 [95% confidence interval {CI} 1.09-1.92] for all patients, and 1.42 [95% CI 1.02-1.97] and 1.60 [95% CI 1.01-2.54] for biopsy-naïve and prior negative biopsy patients, respectively). Detection rates were not significantly different between pathways for cisPCa (0.89 [95% CI 0.49-1.62]), but higher in the MRI-stratified pathway for the detection of any PCa (1.39 [95% CI 1.05-1.84]). CONCLUSIONS: The MRI-stratified pathway detected more csPCa than the systematic TRUS-guided biopsy pathway in men with a clinical suspicion of PCa, for both biopsy-naïve patients and those with prior negative biopsy. The detection rate of any PCa was higher in the MRI-stratified pathway, but not significantly different from that of cisPCa. PATIENT SUMMARY: Our meta-analysis of clinical trials shows that the magnetic resonance imaging-stratified pathway detects more clinically significant prostate cancers than the transrectal ultrasound-guided prostate biopsy pathway in men with a suspicion of prostate cancer. Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords:	magnetic resonance imaging; biopsy; prostate cancer; systematic review; meta-analysis; targeted biopsy
Journal Title:	European Urology Oncology
Volume:	2
Issue:	6
ISSN:	2588-9311
Publisher:	Elsevier BV
Date Published:	2019-11-01
Start Page:	605
End Page:	616
Language:	English
DOI:	10.1016/j.euo.2019.05.004
PUBMED:	31204311
PROVIDER:	scopus
PMCID:	PMC7406122
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074965294&doi=10.1016%2fj.euo.2019.05.004&partnerID=40&md5=dfad29cdc599ad1e8611716e649be6fd
Notes:	Review -- Export Date: 2 December 2019 -- Source: Scopus

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