Should we perform systematic biopsies in case of suspicious MRI for prostate cancer in 2020? A review of literature

Vesval, Q.; Fiard, G.; Villers, Arnauld; Norris, Joseph M.; Olivier, Jonathan

doi:10.1016/j.purol.2020.09.025

Cited by 4 publications

(1 citation statement)

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“…MRI-TB were rapidly integrated in the PCa diagnostic pathway, with the hope that omitting systematic sampling would be associated with a reduced risk of detecting non-csPCa, shorter procedures and reduced patient discomfort and biopsy complications, but this strategy was also shown to impair the accurate prediction of pathological features at radical prostatectomy (29). Given the false-negative rate of MRI and MRI-TB in the initial biopsy and active surveillance settings, SB remain recommended in addition to MRI-TB, while SB can now be omitted in patients with previous negative biopsies (35), representing 26-74% of the patients included in this meta-analysis. Recent publications suggested that the increased sensitivity of SB added to MRI-TB may be explained by the presence of csPCa also in the perilesional biopsies (penumbra), introducing the potential benefit from perilesional saturation biopsy (36).…”

Section: Discussionmentioning

confidence: 99%

Micro-ultrasound-guided biopsies versus systematic biopsies in the detection of prostate cancer: a systematic review and meta-analysis

et al. 2022

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Purpose:The diagnosis of prostate cancer (PCa) still relies on the performance of both targeted (TB) and systematic biopsies (SB). Micro-ultrasound (mUS)-guided biopsies demonstrated a high sensitivity in detecting clinically significant prostate cancer (csPCa), which could be comparable to that of magnetic resonance imaging (MRI)-TB, but their added value has not been compared to SB yet. Methods:We conducted a systematic review and meta-analysis, based on Medline, EMBASE, Scopus and Web of Science, in accordance with PRISMA guidelines, to compare mUS-guided biopsies to SB. Results:Based on the literature search of 2957 articles, 15 met the inclusion criteria (2967 patients). Most patients underwent mUS-guided biopsies, followed by MRI-TB and SB. Respectively 5 (n=670) and 4 (n=467) studies, providing raw data on SB, were included in a random-effect meta-analysis of the detection rate of csPCa, ie. Gleason Grade Group (GGG) ≥ 2, or non-csPCa (GGG=1). Overall, PCa was detected in 56-71% of men, with 31.3-49% having csPCa and 17-25.4% having non-csPCa. Regarding csPCa, mUS-guided biopsies identified 196 and SB 169 cases (Detection Ratio (DR): 1.18, 95% CI: 0.83 to 1.68, I 2 =69%), favoring mUSguided biopsies; regarding non-csPCa, mUS-guided biopsies identified 62 and SB 115 cases (DR: 0.55, 95% CI: 0.41 to 0.73, I 2 =0%), also favoring mUS-guided biopsies by decreasing unnecessary diagnosis. Conclusion:Micro-ultrasound-guided biopsies compared favorably with SB for the detection of csPCa and detected fewer non-csPCa than SB. Prospective trials are awaited to confirm the interest of adding mUS-guided biopsies to MRI-TB to optimize csPCa detection without increasing overdiagnosis of non-csPCa.

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Section: Discussionmentioning

confidence: 99%