Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer

Abstract

MRI pathway missed 12% (2 to 23) less than SBx 6944 (25) 13 15 NA 8 Cochrane Library Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic ReviewsProstate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer (Review)

Performance of Combined Magnetic Resonance Imaging/Ultrasound Fusion-guided and Systematic Biopsy of the Prostate in Biopsy-naïve Patients and Patients with Prior Biopsies

“…MRI fusion-guided biopsy is gaining more acceptance in the diagnostic workup of PCa [5,[12][13][14][15][16]. However, the performance of SB in combination with TB in various biopsy scenarios is still debatable.…”

“…As recent prospective studies showed superiority of targeted biopsies (TBs) compared with systematic biopsies (SBs), magnetic resonance imaging (MRI) is gaining wider acceptance in the diagnostic setup of prostate cancer (PCa) [1][2][3][4][5][6]. To date, the European Association of Urology (EAU) guidelines on prostate cancer strongly recommend to perform multiparametric MRI (mpMRI) if PCa is clinically suspected and a previous SB demonstrated negative results [7].…”

Association between PSA density and prostate cancer in men without significant MRI lesions

“…The attempt to establish specific parameters in the post‐MRI setting adressing this matter is therefore inevitable. In pooled studies on biopsy‐naïve patients and patients with prior negative biopsies, it was observed that a Likert/PI‐RADS threshold of ≥3 would have missed 11% (95% CI 6–18) of all detected International Society of Urological Pathology (ISUP) grade >2 cancers [1]. In the context of false‐negative rates of up to 50% for random systematic biopsies in the pre‐MRI era, this missed rate may not sound alarming; however, MRI‐invisible prostate cancer (any grade group detected by systematic biopsy) is a frequent clinical finding and its frequency strongly depends on the radiologist’s experience, biopsy indication and technique (number of cores).…”

Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

“…In practice, a binary MRI decision model for determining biopsy need has been introduced, with MRI-negative tests defined as PI-RADS assessment category 1 or 2, and MRI-positive tests defined as PI-RADS assessment categories 3, 4, or 5. For detecting clinically significant prostate cancer, this binary MRI decision model has been shown to have high sensitivity (0.91; 95% CI: 0.83, 0.95) and low specificity (0.37; 95% CI: 0.29, 0.46), when referenced to template-guided mapping verification biopsies [6]. False positives have been shown to occur predominantly within PI-RADS category 3 and 4 lesions, and less so in category 5 lesions [37,38].…”

“…Magnetic resonance imaging (MRI) is an increasingly useful tool for clinically significant prostate cancer detection and has recently come to the forefront in the diagnostic work-up in many countries [1][2][3]. Its utility has been demonstrated by multiple prospective studies including randomized clinical trials [4,5] and multiple, systematic analyses that consistently show improvements in biopsy avoidance, reductions in the detection of indolent disease and improved detection of clinically significant disease [6,7]. Prospective multicenter studies as the recently published 'MRI-first' [8] and '4 M' trials [9] show the beneficial effects in prostate cancer detection in biopsy-naïve men, when MRI is combined with systematic and targeted biopsies.…”