Limited evidence for the use of imaging to detect prostate cancer: a systematic review

OBJECTIVE

To assess the diagnostic accuracy of imaging technologies for detecting prostate cancer in patients with elevated PSA-values or suspected findings on clinical examination.

METHODS

The databases Medline, EMBASE, Cochrane, CRD HTA/DARE/NHS EED and EconLit were searched until June 2013. Pre-determined inclusion criteria were used to select full text articles. Risk of bias in individual studies was rated according to QUADAS or AMSTAR. Abstracts and full text articles were assessed independently by two reviewers. The performance of diagnostic imaging was compared with systematic biopsies (reference standard) and sensitivity and specificity were calculated.

RESULTS

The literature search yielded 5141 abstracts, which were reviewed by two independent reviewers. Of these 4852 were excluded since they did not meet the inclusion criteria. 288 articles were reviewed in full text for quality assessment. Six studies, three using MRI and three using transrectal ultrasound were included. All were rated as high risk of bias. Relevant studies on PET/CT were not identified.

CONCLUSION

Despite clinical use, there is insufficient evidence regarding the accuracy of imaging technologies for detecting cancer in patients with suspected prostate cancer using TRUS guided systematic biopsies as reference standard.

The effect of regular professional plaque removal on dental caries in vivo. A polarized light and scanning electron microscope study

This study aims to describe the histological and ultrastructural enamel reactions to regular disturbance/removal of dental plaque, using an in vivo caries model. Fourteen young volunteers undergoing orthodontic treatment participated in the study. To create local protected areas, orthodontic bands with a buccal space were placed in homologous pairs of premolars. One tooth in each pair served as control and had the band cemented for the entire test period of 5 weeks. The other band was removed weekly and the buccal surface cleaned, either by careful pumicing with a nonfluoride toothpaste, or by simple cleaning with a cotton pellet. Results indicated that 5 weeks with completely undisturbed plaque accumulation resulted in visible enamel demineralization in all 14 individuals, whilst a weekly performed professional plaque removal was able to prevent lesion progress independent of the cleaning procedure. It is therefore concluded that regular mechanical disturbance of dental plaque is able to suppress bacterial activity and hence caries development.