Elsevier

Clinical Oncology

Volume 28, Issue 9, September 2016, Pages 550-567
Clinical Oncology

Overview
Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer: A Systematic Review

https://doi.org/10.1016/j.clon.2016.05.003Get rights and content

Highlights

  • A systematic review on MPMRI in diagnosing prostate cancer.

  • MPMRI targeted biopsy is not recommended in elevated-risk biopsy-naïve patients.

  • MPMRI targeted biopsy may be helpful in growing-risk negative-biopsy patients.

Abstract

A systematic review was conducted to investigate the use of multiparametric magnetic resonance imaging (MPMRI) followed by targeted biopsy in the diagnosis of clinically significant prostate cancer (CSPC) and to compare it with transrectal ultrasound-guided (TRUS-guided) systematic biopsy in patients with an elevated risk of prostate cancer who are either biopsy-naive or who have a previous negative TRUS-guided biopsy. MEDLINE, PubMed and EMBASE (1997 to April 2014), the Cochrane Library and six relevant conferences were searched to find eligible studies. Search terms indicative of ‘prostate cancer’ and ‘magnetic resonance imaging’ with their alternatives were used. Twelve systematic reviews, 52 full texts and 28 abstracts met the preplanned study selection criteria; data from 15 articles were extracted. In patients with an elevated risk of prostate cancer who were biopsy-naive, MPMRI followed by targeted biopsy could detect 2–13% of CSPC patients whom TRUS-guided systematic biopsy missed; TRUS-guided systematic biopsy could detect 0–7% of CSPC patients whom MPMRI followed by targeted biopsy missed. In patients with an elevated risk of prostate cancer who had a previous negative TRUS-guided biopsy, MPMRI followed by targeted biopsy detected more CSPC patients than repeated TRUS-guided systematic biopsy in all four studies, with a total of 516 patients, but only one study reached a statistically significant difference. In patients with an elevated risk of prostate cancer who are biopsy-naive, there is insufficient evidence for MPMRI followed by targeted biopsy to be considered the standard of care. In patients who had a prior negative TRUS-guided systematic biopsy and show a growing risk of having CSPC, MPMRI followed by targeted biopsy may be helpful to detect more CSPC cases as opposed to a repeat TRUS-guided systematic biopsy.

Section snippets

Statement of Search Strategies Used and Sources of Information

The following resources were checked for existing systematic reviews published from 2010 to October 2013: National Guideline Clearinghouse, National Health and Medical Research Council, New Zealand Guidelines Group, American Society of Clinical Oncology (ASCO), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), European Society of Radiotherapy

Literature Search

The following resources were checked for relevant existing systematic reviews that were published from 2010 to October 2013: National Guideline Clearinghouse, National Health and Medical Research Council, New Zealand Guidelines Group, American Society of Clinical Oncology (ASCO), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), European Society

Literature Search Results

In total, 12 systematic reviews [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16] were relevant and met the preplanned inclusion criteria. However, none of them used the same study selection criteria as ours. Thus, these 12 reviews were not discussed further. However, a check of the included studies in these systematic reviews was carried out.

Of 8663 citations identified for original studies, 8301 articles were excluded after reviewing the titles and abstracts and 52 met our

Diagnostic Accuracy Outcome

In the Komai et al. study [56], the sensitivity and specificity of MPMRI to detect CSPC was 86% (95% confidence interval 78–94) and 72% (95% confidence interval 67–78), respectively (Table 2).

In the Abd-Alazeez et al. study [58], each half of the prostate from every patient was treated as one sample size when calculating diagnostic outcomes. When a prostate imaging-reporting and data (PI-RAD) threshold of ≥4 of 5 scores was used for positive MRI results compared with that of PI-RAD ≥3 of 5

Diagnostic Accuracy Outcomes

The overall sensitivity for MPMRI to identify CSPC ranged from 68 to 100% and specificity ranged from 41 to 91% in three studies [61], [65], [66] (Table 2). In the Hoeks et al. study [61], the sensitivity and negative predictive value for MPMRI and MPMRI followed by targeted biopsy were similar and high (92% versus 93% and 94% versus 96%, respectively), but the specificity and positive predictive value were different (41% versus 91%; 33% versus 87%, respectively).

In the Abd-Alazeez et al. study

Discussion

This systematic review showed that in biopsy-naive patients with an elevated risk of prostate cancer (prevalence of 21–30% for CSPC), 6–32% of true CSPC patients were falsely diagnosed negative and 28–79% of non-CSPC patients were falsely diagnosed positive after MPMRI examination; in patients with MPMRI-positive results, 50–76% were falsely diagnosed positive; in patients with MPMRI-negative results, 6–17% were falsely diagnosed negative (Table 2). Between 2 and 13% of patients were diagnosed

Conclusions

Based on the existing evidence, we would not recommend MPMRI followed by targeted biopsy as a standard care in biopsy-naive patients with an elevated risk of prostate cancer (according to PSA levels and/or nomograms). In patients who had a prior negative TRUS-guided systematic biopsy and show a growing risk of having CSPC (e.g. continued significant rise in PSA), MPMRI followed by targeted biopsy may be helpful to detect more CSPC cases as opposed to a repeat TRUS-guided systematic biopsy.

Conflicts of Interest

MH received grants from Sentinelle Medical Company for prostate coil evaluation and is one of the principal investigators in several clinical trials related to MRI application in prostate research. AL received more than $5000 totally in a single year to act in a consulting capacity from Elekta and GE and is one of the principal investigators in several clinical trials related to MRI application in prostate research.

Acknowledgements

The authors would like to thank W. Hijazi for his contribution towards the data audit and members from the MRI in Prostate Cancer Guideline Development Group in Ontario (G. Bauman, R. Breau, J. Chin, W. Chu, J. Dobranowski, S. Ghai, K.S. Jhaveri, L. Klotz, D. Langer, B. Shayegan) for their comments on the early draft of this project.

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