Patient-Centered Outcomes From Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: A Systematic Review

Abstract

Objective: To identify and characterize patient-centered outcomes (PCOs) relating to multiparametric MRI (mpMRI) and MRIguided biopsy as diagnostic tests for possible prostate cancer.Methods: Medline via OVID, EMBASE, PsycInfo, and the Cochrane Central register of Controlled Trials (CENTRAL) were searched for relevant articles. Hand searching of reference lists and snowballing techniques were performed. Studies of mpMRI and MRI-guided biopsy that measured any PCO were included. There were no restrictions placed on year of publication, language, or country for study inclusion. All database search hits were screened independently by two reviewers, and data were extracted using a standardized form.Results: Overall, 2,762 database search hits were screened based on title and abstract. Of these, 222 full-text articles were assessed, and 10 studies met the inclusion criteria. There were 2,192 participants featured in the included studies, all of which were conducted in high-income countries. Nineteen different PCOs were measured, with a median of four PCOs per study (range 1-11). Urethral bleeding, pain, and urinary tract infection were the most common outcomes measured. In the four studies that compared mpMRI or MRI-guided biopsy to transrectal ultrasound biopsy, most adverse outcomes occurred less frequently in MRI-related tests. These four studies were assessed as having a low risk of bias. Discussion: PCOs measured in studies of mpMRI or MRI-guided biopsy thus far have mostly been physical outcomes, with some evidence that MRI tests are associated with less frequent adverse outcomes compared with transrectal ultrasound biopsy. There was very little evidence for the effect of mpMRI and MRI-guided biopsy on emotional, cognitive, social, or behavioral outcomes.

Imaging of clinically silent rectoprostatic hematoma in MRI guided in-bore prostate biopsy

“…Temporary erectile dysfunction is described after prostate biopsy in 11–26% using different approaches and completely recovers after 1–3 months. The etiology needs to be further clarified 6 , 7 , 10 , 16 , 22 .…”

“…Nevertheless, safety considerations should also be a key issue, as well as cancer detection in discussions on the best biopsy strategy. Transperineal mapping biopsy leads to a high rate of urinary retention rate and erectile dysfunction but shows a lower rate of infection compared to transrectal biopsy 2 , 7 , 10 . In comparison to systematic TRUS biopsy, transrectal in-bore MR-guided targeted biopsy implies a considerably reduced number of cores obtained, and the rate of complications is reported to be lower 6 , 8 , 11 .…”

“…Perineal hematomas are well recognized in transperineal prostate biopsies, they are clinically visible. In contrast, periprostatic hematomas are only recognized by imaging and may be missed as a possible cause of pain or erectile dysfunction 7 , 12 – 14 .…”

Cost‐effectiveness of multiparametric magnetic resonance imaging and MRI‐guided biopsy in a population‐based prostate cancer screening setting using a micro‐simulation model

“…There is more risks of complication and subsequent increment of health care costs due to TRUSGB biopsy than MRI-guided biopsy. 36,37 Therefore, the cost-effectiveness would be even more in favor of the MRI screening pathway if these costs were included. Second, assumptions were made for certain model parameters when data are not available.…”

The comparative effectiveness of mpMRI and MRI-guided biopsy vs regular biopsy in a population-based PSA testing: a modeling study

“…The utility estimate (0.96) and duration (1 week) for mpMRI were based on Grana et al 27 . There is evidence that MRIGB is associated with less frequent adverse outcomes compared with TRUSGB 3 . Therefore, we assumed 50% lower disutility for MRIGB compared with that of TRUSGB.…”