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Basourakos SP, Alshak MN, Lewicki PJ, Cheng E, Tzeng M, DeRosa AP, Allaway MJ, Ross AE, Schaeffer EM, Patel HD, Hu JC, Gorin MA. Role of Prophylactic Antibiotics in Transperineal Prostate Biopsy: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 37:53-63. [PMID: 35243391 PMCID: PMC8883190 DOI: 10.1016/j.euros.2022.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 12/25/2022] Open
Abstract
CONTEXT Transperineal prostate biopsy is associated with a significantly lower risk of infectious complications than the transrectal approach. In fact, the risk of infectious complications with transperineal prostate biopsy is so low that the utility of administering periprocedural antibiotics with this procedure has come under question. OBJECTIVE To perform a systematic review and meta-analysis to assess for differences in the rates of infectious complications (septic, nonseptic, and overall) after performing transperineal prostate biopsy with and without the administration of periprocedural antibiotic prophylaxis. EVIDENCE ACQUISITION Three electronic databases (PubMed, Embase, and MEDLINE) were searched, and studies were included if they included patients who underwent transperineal prostate biopsy, were published after January 2000, included information on periprocedural antibiotic administration, and reported postbiopsy complications. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Agency for Healthcare Research and Quality guidelines were utilized. EVIDENCE SYNTHESIS A total of 106 unique studies describing 112 cohorts of patients were identified, of which 98 (37 805 men) received antibiotic prophylaxis and 14 (4772 men) did not receive it. All patients were included in the analysis of septic complications. In total, there were 19/37 805 (0.05%) episodes of sepsis in the group of men who received antibiotics, which was similar to the no antibiotic group with 4/4772 (0.08%) episodes (p = 0.2). For overall infections (septic plus nonseptic), there were 403/29 880 (1.35%) versus 58/4772 (1.22%) events among men with evaluable data who received and did not receive antibiotic prophylaxis, respectively (p = 0.8). Restricting our analysis to studies with a comparable low number of biopsy cores (<25 cores), there remained no difference in the rates of sepsis between groups, but there was a small, statistically significant lower risk of infectious complications with antibiotic administration-67/12 140 (0.55%) versus 58/4772 (1.22%; p < 0.01). CONCLUSIONS The likelihood of septic infections after transperineal prostate biopsy is low with and without antibiotic prophylaxis. The omission of periprocedural antibiotics with this procedure stands to benefit patients by avoiding potential drug reactions. Furthermore, this practice is in line with calls throughout the medical community for improved antibiotic stewardship. PATIENT SUMMARY In a large systematic review and meta-analysis, we evaluated infectious complications after transperineal prostate biopsy with or without the administration of prophylactic antibiotics. We conclude that prophylactic antibiotics do not decrease the rate of postbiopsy sepsis but may have a small benefit in terms of preventing less serious infections.
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Affiliation(s)
- Spyridon P. Basourakos
- Department of Urology, New York Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Mark N. Alshak
- Department of Urology, New York Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Patrick J. Lewicki
- Department of Urology, New York Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Emily Cheng
- Department of Urology, New York Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Michael Tzeng
- Department of Urology, New York Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Antonio P. DeRosa
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Ashley E. Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edward M. Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hiten D. Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Jim C. Hu
- Department of Urology, New York Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Michael A. Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bass EJ, Pantovic A, Connor MJ, Loeb S, Rastinehad AR, Winkler M, Gabe R, Ahmed HU. Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2021; 25:174-179. [PMID: 34548624 PMCID: PMC9184263 DOI: 10.1038/s41391-021-00449-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022]
Abstract
Background Multiparametric MRI localizes cancer in the prostate, allowing for MRI guided biopsy (MRI-GB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRI-GB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and MRI ‘in-bore’ biopsy (IB-TB). It is unknown whether any of these are superior. We conducted a systematic review and meta-analysis to address three questions. First, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Second, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Third, whether any MRI-GB strategy is superior at detecting csPCa. Methods A systematic literature review from 2015 to 2019 was performed in accordance with the START recommendations. Studies reporting PCa detection rates, employing MRI-GB and TRUS-GB were included and evaluated using the QUADAS-2 checklist. 1553 studies were found, of which 43 were included in the meta-analysis. Results For csPCa, MRI-GB was superior in detection to TRUS-GB (0.83 vs. 0.63 [p = 0.02]). MRI-GB was superior in detection to TRUS-GB at avoiding detection of insignificant PCa. No MRI-GB technique was superior at detecting csPCa (IB-TB 0.87; COG TB 0.81; FUS-TB 0.81, [p = 0.55]). There was significant heterogeneity observed between the included studies. Conclusions In patients with suspected PCa on MRI, MRI-GB offers superior rates of csPCa detection and reduces detection of insignificant PCa compared to TRUS-GB. No individual MRI-GB technique was found to be better in csPCa detection. Prospective adequately powered randomized controlled trials are required.
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Affiliation(s)
- E J Bass
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - A Pantovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research -, Belgrade, Serbia
| | - M J Connor
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - S Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
| | - A R Rastinehad
- Department of Urology, Lenox Hill Hospital at Northwell Health, New York, NY, USA
| | - M Winkler
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - H U Ahmed
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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van der Slot MA, Boerma MO, Koster K, van Gorp A, Kolderman SE, Wolters T. The value of MRI in the detection of prostate cancer in a peripheral center. Urologia 2021; 89:70-74. [PMID: 34219558 DOI: 10.1177/03915603211028553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study evaluated the value of pre-biopsy MRI and target biopsy in detection of significant prostate cancer in a peripheral center. METHODS A retrospective study included all patients of whom a MRI of the prostate was performed before biopsy, initial and repeated biopsy, between June 2016 and May 2017. Patients underwent transrectal ultrasound guided 8-12 cores prostate biopsy and cognitive fusion target biopsy was performed if a suspicious lesion was seen on MRI. The prostate cancer detection was compared between the MRI cognitive target biopsy and standard random biopsy. RESULTS In a total of 265 patients a MRI was performed of whom 115 underwent prostate biopsy, 96 patients underwent MRI before initial biopsies and 19 patients had previous negative biopsies. In the initial biopsy group 83 MRI's were abnormal and only 7 (8.4%) target biopsies had an additional value in detecting or upstaging prostate cancer. Prostate cancer was found in 4 of 13 (30.8%) normal MRI's. In the prior negative biopsy group, 4 of 18 abnormal MRI's had an additional value in upstaging or detecting prostate cancer. CONCLUSION In this study the pre-biopsy MRI had a limited additional value compared to standard biopsy in detecting or upstaging prostate cancer.
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Affiliation(s)
| | - Michiel O Boerma
- Department of Urology, Deventer Hospital, Deventer, The Netherlands
| | - Kenneth Koster
- Department of Radiology, Deventer Hospital, Deventer, The Netherlands
| | | | | | - Tineke Wolters
- Department of Urology, Deventer Hospital, Deventer, The Netherlands
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mpMRI-targeted biopsy versus systematic biopsy for clinically significant prostate cancer diagnosis: a systematic review and metaanalysis. Curr Opin Urol 2020; 30:711-719. [PMID: 32732624 DOI: 10.1097/mou.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We aimed to compare the accuracy of clinically significant prostate cancer (csPCa) diagnosis by magnetic resonance imaging-targeted biopsy (MRI-TB) versus systematic biopsy (SB) in men suspected of having prostate cancer (PCa). RECENT FINDINGS In biopsy-naïve patients, MRI-TB was more accurate to identify csPCa than SB. However, when comparing specifically MRI-TB versus transperineal (SB), we did not find any difference. Furthermore, in a repeat biopsy scenario, MRI-TB found more csPCa than SB as well. Finally, postanalysis comparing combined biopsy (SB plus MRI-TB) suggests that the later alone may play a role in both scenarios for identifying csPCa. SUMMARY MRI-TB found more csPCa than SB in patients with suspected PCa in both scenarios, naïve and repeat biopsies, but more studies comparing those methods are warranted before any recommendation on this topic.
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Robotic-assisted transrectal MRI-guided biopsy. Technical feasibility and role in the current diagnosis of prostate cancer: an initial single-center experience. Abdom Radiol (NY) 2020; 45:4150-4159. [PMID: 32705314 DOI: 10.1007/s00261-020-02665-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate the potential clinical and technical utility to manage in practice the use of a robotic MRI in-bore-targeted prostate biopsies in the current work-up of prostate cancer diagnosis. METHODS Thirty patients with a single cancer suspicious lesion interpreted on MRI using PI-RADSv2.1 category ≥ 3 underwent in-bore robotic transrectal MRI remote-controlled-guided biopsy. It was analyzed the technical success, clinical details, biopsy findings in correlation with the MRI examination, complications and cancer detection rate (CDR). RESULTS The overall CDR for any cancer was 73% (22/30). It was 86% (19/22) for significant tumors (Gleason score of more than 6 or maximum cancer core length greater than 3 mm for Gleason 6) and 77% (17/22) for tumors with Gleason > 6. CDR for biopsy-naïve patients was 89% (16/18) and 50% (6/12) for patients with prior negative transrectal ultrasound-guided biopsies. The CDR for PI-RADS > 3 was 92% (22/24). All the lesions (n = 30) were reachable with the robotic MRI device. A self-limited rectal hemorrhagic complication was reported. CONCLUSION This initial data show that a robotic MRI-guided biopsy could be useful, efficient and feasible procedure in the new paradigm to diagnose significant prostate cancer in selected patients.
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Cornud F, Lefevre A, Flam T, Dumonceau O, Galiano M, Soyer P, Camparo P, Barral M. MRI-directed high-frequency (29MhZ) TRUS-guided biopsies: initial results of a single-center study. Eur Radiol 2020; 30:4838-4846. [PMID: 32350662 DOI: 10.1007/s00330-020-06882-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 04/09/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the ability of high-frequency (29 MHz) transrectal micro-ultrasound (microUS) as a second-look examination after biparametric MRI (bp-MRI) and to reidentify focal lesions seen on diagnostic MRI and to detect new ones METHODS: A total of 118 consecutive men (mean age, 66 ± 13 [SD] years; range, 49-93 years) with a mean prostate-specific antigen level of 11 ± 19 (SD) ng/mL (range, 2-200 ng/mL) and at least one focal lesion (MRI+) with a score > 2 on bp-MRI were included. Of these, 79/118 (66.9%) were biopsy-naïve and 102/118 (86.5%) had non-suspicious rectal examination. All patients had MRI-directed microUS-guided biopsy using a 29-MHz transducer. All lesions visible on micro-ultrasound (microUS+) were targeted without image fusion, which was only used for MRI+/microUS- lesions. Significant prostate cancer (sPCa) was defined by a Gleason score ≥ 7 or a maximum cancer core length > 3 mm. RESULTS A total of 144 focal prostatic lesions were analyzed, including 114 (114/144, 79.2%) MRI+/microUS+ lesions, 13 MRI+/microUS- lesions (13/144, 9%), and 17 MRI-/microUS+ lesions (17/144, 11.8%). Significant PCa was detected in 70 MRI+/microUS+ lesions (70/114, 61.4%), in no MRI+/microUS- lesion (0/13, 0%), and in 4 MRI-/microUS+ lesions (4/17, 23.5%). The sensitivity and specificity of microUS on a per-patient and a per-lesion basis were 100% (95% CI, 84.9-100%) and 22.8% (95% CI, 12.5-35.8%) and 100% (95% CI, 85.1-100%) and 22.6% (95% CI, 12.3-36.2%), respectively. CONCLUSION MicroUS, as a second-look examination, may show promise to localize targets detected on bp-MRI. KEY POINTS • Used as a second-look examination, microUS-guided biopsies have a 100% detection rate of sCa originating in the PZ or lower third of the TZ, without microUS-MRI image fusion. • MicroUS results may provide additional information about lesions visible on MRI. • MicroUS may provide the ability to detect small PZ lesions undetected by bp-MRI.
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Affiliation(s)
- François Cornud
- Department of Radiology, Clinique de l'Alma, Paris, France. .,Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France.
| | - Arnaud Lefevre
- Department of Radiology, Clinique de l'Alma, Paris, France
| | - Thierry Flam
- Department of Urology, Clinique St Jean de Dieu, Paris, France
| | | | - Marc Galiano
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France.,Université de Paris Descartes Paris V, Paris, France
| | | | - Matthias Barral
- Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France
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Tu X, Liu Z, Zhang C, Chang T, Xu H, Bao Y, Li J, Jin K, Yuan Q, Qiu S, Yang L, Wei Q. Diagnostic Role of Magnetic Resonance Imaging-Targeted Biopsy for Prostate Cancer in Biopsy-Naïve Men: A Meta-Analysis. Urol Int 2019; 104:187-198. [DOI: 10.1159/000504028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 11/19/2022]
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8
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In-Bore Transrectal MRI–Guided Biopsy With Robotic Assistance in the Diagnosis of Prostate Cancer: An Analysis of 57 Patients. AJR Am J Roentgenol 2019; 213:W171-W179. [DOI: 10.2214/ajr.19.21145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Transperineal Magnetic Resonance Imaging–Targeted Biopsy May Perform Better Than Transrectal Route in the Detection of Clinically Significant Prostate Cancer: Systematic Review and Meta-analysis. Clin Genitourin Cancer 2019; 17:e860-e870. [DOI: 10.1016/j.clgc.2019.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 05/12/2019] [Indexed: 12/17/2022]
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Barat M, Colleter L, Mongiat-Artus P, Jolibois Z, Quero L, Hennequin C, Desgrandchamps F, de Kerviler E. Salvage cryoablation for local recurrence of prostatic cancer after curative therapy. Diagn Interv Imaging 2019; 100:679-687. [PMID: 31331832 DOI: 10.1016/j.diii.2019.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to determine the efficacy of salvage cryotherapy for intra-prostatic and local extraprostatic recurrences after curative treatment of prostate adenocarcinoma. MATERIAL AND METHOD Twenty-eight men (mean age, 69±6 [SD] years; range: 51-82 years) treated with cryoablation for prostatic (N=21) or extraprostatic (N=7) recurrent prostate cancer after radiotherapy with or without associated prostatectomy were included. Technical success, complication and recurrences were reported. Biological recurrence was defined as an elevation ≥2ng/mL of prostate specific antigen (PSA) serum level after the treatment. RESULTS The mean follow-up was 18 months. Among the 21 patients with intraprostatic recurrence, 14 had successful cryotherapy with a mean decrease in serum prostate-specific antigen (PSA) levels of -5.7±2.6 (SD) ng/mL (range: -2.1 to -16.9ng/mL). Four patients (19%) had early progression and three patients (14%) had delayed biological recurrence (mean time: 15 months). Among the 7 patients with extraprostatic recurrence, 2/7 (291%) had successful cryotherapy with a decrease in PSA serum level of -2.7±1.6 (SD) ng/mL (range: -0.5--5.5ng/mL) and 4/7 (57%) had early biological recurrence after cryotherapy that required androgen deprivation therapy, whereas 1/7 (4%) was lost to follow-up. No major complications were observed for both intra- and extraprostatic recurrence. CONCLUSION Salvage cryoablation of locally recurrent prostate cancer after curative treatment is feasible and safe when the half prostate is treated. It could delay initiation of androgen deprivation therapy in these patients.
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Affiliation(s)
- M Barat
- Department of Radiology, Hôpital Cochin, AP-HP, & Université de Paris-Descartes Paris 5,, 75014 Paris, France.
| | - L Colleter
- Department of Radiology, Hôpital Saint-Louis, APHP & Université de Paris-Diderot Paris 7, 75010 Paris, France
| | - P Mongiat-Artus
- Department of Urology, Hôpital Saint-Louis & Université de Paris-Diderot Paris 7, 75010 Paris, France
| | - Z Jolibois
- Department of Radiology, Hôpital Saint-Louis, APHP & Université de Paris-Diderot Paris 7, 75010 Paris, France
| | - L Quero
- Department of Radiation Oncology, Hôpital Saint-Louis & Université de Paris-Diderot Paris 7, 75010 Paris, France
| | - C Hennequin
- Department of Radiation Oncology, Hôpital Saint-Louis & Université de Paris-Diderot Paris 7, 75010 Paris, France
| | - F Desgrandchamps
- Department of Urology, Hôpital Saint-Louis & Université de Paris-Diderot Paris 7, 75010 Paris, France
| | - E de Kerviler
- Department of Radiology, Hôpital Saint-Louis, APHP & Université de Paris-Diderot Paris 7, 75010 Paris, France
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Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, Schoots IG. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019; 4:CD012663. [PMID: 31022301 PMCID: PMC6483565 DOI: 10.1002/14651858.cd012663.pub2] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI), with or without MRI-targeted biopsy, is an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of having prostate cancer. At present, evidence on which test to use is insufficient to inform detailed evidence-based decision-making. OBJECTIVES To determine the diagnostic accuracy of the index tests MRI only, MRI-targeted biopsy, the MRI pathway (MRI with or without MRI-targeted biopsy) and systematic biopsy as compared to template-guided biopsy as the reference standard in detecting clinically significant prostate cancer as the target condition, defined as International Society of Urological Pathology (ISUP) grade 2 or higher. Secondary target conditions were the detection of grade 1 and grade 3 or higher-grade prostate cancer, and a potential change in the number of biopsy procedures. SEARCH METHODS We performed a comprehensive systematic literature search up to 31 July 2018. We searched CENTRAL, MEDLINE, Embase, eight other databases and one trials register. SELECTION CRITERIA We considered for inclusion any cross-sectional study if it investigated one or more index tests verified by the reference standard, or if it investigated the agreement between the MRI pathway and systematic biopsy, both performed in the same men. We included only studies on men who were biopsy naïve or who previously had a negative biopsy (or a mix of both). Studies involving MRI had to report on both MRI-positive and MRI-negative men. All studies had to report on the primary target condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the risk of bias using the QUADAS-2 tool. To estimate test accuracy, we calculated sensitivity and specificity using the bivariate model. To estimate agreement between the MRI pathway and systematic biopsy, we synthesised detection ratios by performing random-effects meta-analyses. To estimate the proportions of participants with prostate cancer detected by only one of the index tests, we used random-effects multinomial or binary logistic regression models. For the main comparisions, we assessed the certainty of evidence using GRADE. MAIN RESULTS The test accuracy analyses included 18 studies overall.MRI compared to template-guided biopsy: Based on a pooled sensitivity of 0.91 (95% confidence interval (CI): 0.83 to 0.95; 12 studies; low certainty of evidence) and a pooled specificity of 0.37 (95% CI: 0.29 to 0.46; 12 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI may result in 273 (95% CI: 249 to 285) true positives, 441 false positives (95% CI: 378 to 497), 259 true negatives (95% CI: 203 to 322) and 27 (95% CI: 15 to 51) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.MRI-targeted biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.80 (95% CI: 0.69 to 0.87; 8 studies; low certainty of evidence) and a pooled specificity of 0.94 (95% CI: 0.90 to 0.97; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI-targeted biopsy may result in 240 (95% CI: 207 to 261) true positives, 42 (95% CI: 21 to 70) false positives, 658 (95% CI: 630 to 679) true negatives and 60 (95% CI: 39 to 93) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.The MRI pathway compared to template-guided biopsy: Based on a pooled sensitivity of 0.72 (95% CI: 0.60 to 0.82; 8 studies; low certainty of evidence) and a pooled specificity of 0.96 (95% CI: 0.94 to 0.98; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, the MRI pathway may result in 216 (95% CI: 180 to 246) true positives, 28 (95% CI: 14 to 42) false positives, 672 (95% CI: 658 to 686) true negatives and 84 (95% CI: 54 to 120) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations, inconsistency and imprecision.Systemic biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.63 (95% CI: 0.19 to 0.93; 4 studies; low certainty of evidence) and a pooled specificity of 1.00 (95% CI: 0.91 to 1.00; 4 studies; low certainty of evidence) using a baseline prevalence of 30%, systematic biopsy may result in 189 (95% CI: 57 to 279) true positives, 0 (95% CI: 0 to 63) false positives, 700 (95% CI: 637 to 700) true negatives and 111 (95% CI: 21 to 243) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.Agreement analyses: In a mixed population of both biopsy-naïve and prior-negative biopsy men comparing the MRI pathway to systematic biopsy, we found a pooled detection ratio of 1.12 (95% CI: 1.02 to 1.23; 25 studies). We found pooled detection ratios of 1.44 (95% CI 1.19 to 1.75; 10 studies) in prior-negative biopsy men and 1.05 (95% CI: 0.95 to 1.16; 20 studies) in biopsy-naïve men. AUTHORS' CONCLUSIONS Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed. The certainty in our findings was reduced by study limitations, specifically issues surrounding selection bias, as well as inconsistency. Based on these findings, further improvement of prostate cancer diagnostic pathways should be pursued.
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Affiliation(s)
- Frank‐Jan H Drost
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daniël F Osses
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daan Nieboer
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ewout W Steyerberg
- Erasmus University Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Chris H Bangma
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Monique J Roobol
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ivo G Schoots
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
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Rouviere O, Moldovan PC. The current role of prostate multiparametric magnetic resonance imaging. Asian J Urol 2018; 6:137-145. [PMID: 31061799 PMCID: PMC6488694 DOI: 10.1016/j.ajur.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/21/2022] Open
Abstract
Prostate multi-parametric magnetic resonance imaging (mpMRI) has shown excellent sensitivity for Gleason ≥7 cancers, especially when their volume is ≥0.5 mL. As a result, performing an mpMRI before prostate biopsy could improve the detection of clinically significant prostate cancer (csPCa) by adding targeted biopsies to systematic biopsies. Currently, there is a consensus that targeted biopsies improve the detection of csPCa in the repeat biopsy setting and at confirmatory biopsy in patients considering active surveillance. Several prospective multicentric controlled trials recently showed that targeted biopsy also improved csPCa detection in biopsy-naïve patients. The role of mpMRI and targeted biopsy during the follow-up of active surveillance remains unclear. Whether systematic biopsy could be omitted in case of negative mpMRI is also a matter of controversy. mpMRI did show excellent negative predictive values (NPV) in the literature, however, since NPV depends on the prevalence of the disease, negative mpMRI findings should be interpreted in the light of a priori risk for csPCa of the patient. Nomograms combining mpMRI findings and classical risk predictors (age, prostate-specific antigen density, digital rectal examination, etc.) will probably be developed in the future to decide whether a prostate biopsy should be obtained. mpMRI has a good specificity for detecting T3 stage cancers, but its sensitivity is low. It should therefore not be used routinely for staging purposes in low-risk patients. Nomograms combining mpMRI findings and other clinical and biochemical data will also probably be used in the future to better assess the risk of T3 stage disease.
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Affiliation(s)
- Olivier Rouviere
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France.,Université de Lyon, Lyon, France.,Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
| | - Paul Cezar Moldovan
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France.,Université de Lyon, Lyon, France.,Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
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Cornud F, Bomers J, Futterer J, Ghai S, Reijnen J, Tempany C. MR imaging-guided prostate interventional imaging: Ready for a clinical use? Diagn Interv Imaging 2018; 99:743-753. [DOI: 10.1016/j.diii.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/08/2018] [Indexed: 01/22/2023]
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Tavolaro S, Mozer P, Roupret M, Comperat E, Rozet F, Barret E, Drouin S, Vaessen C, Lucidarme O, Cussenot O, Boudghène F, Renard-Penna R. Transition zone and anterior stromal prostate cancers: Evaluation of discriminant location criteria using multiparametric fusion-guided biopsy. Diagn Interv Imaging 2018; 99:403-411. [DOI: 10.1016/j.diii.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 01/12/2023]
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15
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Is it time for a magnetic resonance imaging-targeted only prostate biopsy strategy? Diagn Interv Imaging 2017; 98:661-662. [DOI: 10.1016/j.diii.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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