Elsevier

Clinical Oncology

Volume 33, Issue 12, December 2021, Pages e599-e612
Clinical Oncology

Overview
Multiparametric Magnetic Resonance Imaging in the Diagnosis of Clinically Significant Prostate Cancer: an Updated Systematic Review

https://doi.org/10.1016/j.clon.2021.07.016Get rights and content

Highlights

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    For biopsy naïve men MPMRI has an accuracy of diagnosis of CSPCa from 87% to 96% and specificities ranging from 29% to 45%.

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    For biopsy naive men, meta-analyses shows increased detection of CSPCa by MPMRI-TB over TRUS-SB by 3% (95% CI, 0%–7%, p = 0.03) and ecreased detection of CISPCa by MPMRI of 8% (95% CI,-11%–5%, p < 0.00001).

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    For men with prior negative biopsy for prostate cancer MPRI shows sensitivities of 78%–100% and specificities of 30%–100%.

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    For men with prior negative biopsy, meta-analyses comparing MPMR to TRUS-SB showed 5% increased CSPCa detection (95% CI, 3%-7%,p < 0.0001) and 7% reduced CISPCa detection (95% CI, 4%-9%,p < 0.00001)

Abstract

There has been growing utilisation of multiparametric magnetic resonance imaging (MPMRI) as a non-invasive tool to diagnose and localise clinically significant prostate cancer (CSPCa). This updated systematic review examines the use of MPMRI in patients with an elevated risk of CSPCa who have had a prior negative transrectal ultrasound systematic biopsy (TRUS-SB) and who were biopsy naïve. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched for existing systematic reviews published up to September 2020. The literature search of the electronic databases combined disease-specific terms (prostate cancer, prostate carcinoma, etc.) and treatment-specific terms (magnetic resonance, etc.). Studies were included if they were randomised controlled trials (RCTs) comparing MPMRI to template transperineal mapping biopsy (TPMB) or to TRUS-SB. Thirty-six RCTs were eligible. For biopsy-naïve men, accuracy of diagnosis of CSPCa showed sensitivities from 87 to 96% and specificities ranging from 29 to 45%. Meta-analyses for CSPCa showed increased detection favouring MPMRI-targeted biopsy over TRUS-SB by 3% (95% confidence interval 0–7%, P = 0.03) and decreased detection of clinically insignificant prostate cancer (CISPCa) favouring MPMRI by 8% (95% confidence interval –11 to 5%, P < 0.00001). Accuracy of MPMRI for men with prior negative biopsy showed sensitivities of 78–100% and specificities of 30–100%. Meta-analyses comparing MPMRI to TRUS-SB showed increased detection of 5% (95% confidence interval 3–7%, P < 0.0001) with a reduction of CISPCa detection of 7% (95% confidence interval 4–9%, P < 0.00001). The growing acceptance of MPMRI utilisation internationally and the recent publication of several RCTs regarding MPMRI in reducing CISPCa detection rates, particularly in biopsy-naïve men, without loss of sensitivity for CSPCa necessitates the synthesis of updated evidence examining MPMRI in the diagnosis of CSPCa.

Section snippets

Statement of Search Strategies Used and Sources of Information

The following sources were searched for existing systematic reviews, guidelines and primary literature, published from 2013 to September 2020, with search term(s) including prostate cancer, prostate carcinoma, clinically significant, clinically insignificant and magnetic resonance: National Guideline Clearinghouse, National Health and Medical Research Council, New Zealand Guidelines Group, American Society of Clinical Oncology, National Institute for Health and Clinical Excellence, Scottish

Literature Search

The following were searched for existing systematic reviews and guidelines published since 2016: the National Guideline Clearinghouse, National Health and Medical Research Council, New Zealand Guidelines Group, American Society of Clinical Oncology, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews. As no recent systematic reviews that fully met the study inclusion criteria (below)

Literature Search Results

There were no existing guidelines or systematic reviews that fully met the study criteria. Figure 1 shows the primary literature considered for inclusion. Of 9214 citations identified, 5460 duplicate articles were excluded. From the remaining 3754, 3555 were excluded at the abstract and title level and the remaining 199 were examined at the full-text level. Of these, 163 were excluded for various reasons. Thirty-six studies from 39 publications [[6], [7], [8], [9], [10], [11], [12],[22], [23],

Discussion

This report updates a previous systematic review evaluating MPMRI in the diagnosis of CSPCa. The current evidence summary includes 36 studies examining the research questions.

Based on the above evidence, MPMRI is beneficial for men who are biopsy naïve and men with a prior negative TRUS-SB at elevated risk of CSPCa (discordant PSA) as it increases the chance of identifying CSPCa. For the biopsy-naïve men, MPMRI also decreases the need for unnecessary biopsies, whereas for men with a discordant

Conclusions

The growing acceptance of MPMRI utilisation internationally and the recent publication of several RCTs regarding MPMRI in reducing CISPCa detection rates, particularly in biopsy-naïve men, without loss of sensitivity for CSPCa necessitates the synthesis of updated evidence examining MPMRI in the diagnosis of CSPCa.

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

The authors would like to thank members from the MPMRI in the diagnosis of clinically significant prostate cancer Guideline Development Group in Ontario (P. Aprikian, G. Bauman, R. Breau, S. Chang, J. Dobranowski, S. Ghai, L. Klotz, S. Morgan, B. Shayegan) for their comments on the early draft of this project.

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