TY - JOUR
T1 - Identifying optimal prostate biopsy strategy for the detection rate of clinically significant prostate cancer
T2 - A Systematic Re-view and Meta-Analysis of Randomised Controlled Trials (RCTs) in Biopsy-Naïve Population
AU - Aloufi, Wafa
AU - Al Mopti, Abdulrahman
AU - Al Taweel, Anas
AU - Huang, Zhihong
AU - Nabi, Ghulam
N1 - © 2025 by the authors
PY - 2025/1/29
Y1 - 2025/1/29
N2 - Background: The growing role of multiparametric MRI (mpMRI) and MRI-targeted bi-opsy (MRI-TBx) suggests they may replace random systematic biopsy (SBx), specifically detection and subsequent treatment of clinically significant prostate cancer (csPCa). Objectives: To perform a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the detec-tion rates (DR) of csPCa using MRI-TBx alone, SBx alone, or their combination in biopsy naïve pa-tients suspected of having prostate cancer (PCa). Methods: PubMed, MEDLINE, Embase, and the Cochrane Library were searched up to March 23, 2023, for RCTs comparing PCa DR between biopsy strategies in patients with suspected prostate cancer. Detection rates were pooled using ran-dom/fixed effect models and the study quality was assessed using the Cochrane risk of bias revised tool. Results: Ten RCTs (involving 3646 patients) were analysed revealing that the combined biopsy method achieved higher overall and csPCa DR compared to the SBx method alone (RR=1.40 [95% CI =1.15–1.71]and 1.47 [95% CI = 1.13–1.92], respectively). However, there was no significant differ-ence in DR for clinically insignificant prostate cancer (ciPCa) between the two methods. Conclusions: This review concludes that MRI-TBx and SBx detect overall and clinically significant prostate cancer (csPCa) better than SBx alone. The variety of factors requires cautious interpretation, yet these findings are the strongest evidence. The combination technique is recommended for biopsy-naïve groups, but more study is needed to optimise execution and overcome uncertainties.
AB - Background: The growing role of multiparametric MRI (mpMRI) and MRI-targeted bi-opsy (MRI-TBx) suggests they may replace random systematic biopsy (SBx), specifically detection and subsequent treatment of clinically significant prostate cancer (csPCa). Objectives: To perform a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the detec-tion rates (DR) of csPCa using MRI-TBx alone, SBx alone, or their combination in biopsy naïve pa-tients suspected of having prostate cancer (PCa). Methods: PubMed, MEDLINE, Embase, and the Cochrane Library were searched up to March 23, 2023, for RCTs comparing PCa DR between biopsy strategies in patients with suspected prostate cancer. Detection rates were pooled using ran-dom/fixed effect models and the study quality was assessed using the Cochrane risk of bias revised tool. Results: Ten RCTs (involving 3646 patients) were analysed revealing that the combined biopsy method achieved higher overall and csPCa DR compared to the SBx method alone (RR=1.40 [95% CI =1.15–1.71]and 1.47 [95% CI = 1.13–1.92], respectively). However, there was no significant differ-ence in DR for clinically insignificant prostate cancer (ciPCa) between the two methods. Conclusions: This review concludes that MRI-TBx and SBx detect overall and clinically significant prostate cancer (csPCa) better than SBx alone. The variety of factors requires cautious interpretation, yet these findings are the strongest evidence. The combination technique is recommended for biopsy-naïve groups, but more study is needed to optimise execution and overcome uncertainties.
KW - Prostate cancer
KW - Image guided biopsy
KW - Ultrasound
KW - MRI
KW - Prostate cancer sampling
KW - Random systematic biopsy
KW - Meta-analysis
U2 - 10.3390/cancers17030458
DO - 10.3390/cancers17030458
M3 - Article
SN - 2072-6694
VL - 17
JO - Cancers
JF - Cancers
IS - 3
M1 - 458
ER -