Abstract
Background and objective: The PRECISION and PRECISE trials compared magnetic resonance imaging targeted biopsy (MRI±TB) and standard transrectal ultrasound guided biopsy (TRUS) for the detection of clinically significant prostate cancer (csPCa). PRECISION demonstrated superiority of MRI±TB compared to TRUS, while PRECISE demonstrated non-inferiority. The VISION study is a planned individual patient data meta-analysis (IPDMA) comparing MRI±TB to TRUS for csPCa diagnosis.
Methods: MEDLINE, EMBASE, Web of Science, Cochrane Central of Registered Trials and ClinicalTrials.gov were searched on the 12th November 2023 for randomised controlled trials of biopsy-naïve patients with clinical suspicion of PCa undergoing MRI or standard TRUS. Studies were included if those with suspicious MRI underwent targeted biopsy alone, and those with non-suspicious lesion avoided biopsy. Primary outcome is the proportion of men diagnosed with csPCa (Gleason 3+4 or greater).
Key findings: Two studies, PRECISION and PRECISE (953 patients), were included in the IPDMA. In the MRI±TB arm, 32.2% of patients avoided biopsy due to non-suspicious MRI. MRI±TB detected 8.7 percentage points (36.3% vs 27.6%; 95%CI 2.8 to 14.6, p=0.004) more csPCa in comparison to TRUS biopsy and 12.3 percentage points (9.6% vs 21.9%; 95%CI 7.8 to 16.9, p<0.001) less clinically insignificant cancer (cisPCa; Gleason 3+3). The overall risk of bias for the included studies were found to be low after assessment using the QUADAS-2, QUADAS-C and ROB 2.0 tools.
Conclusion: The MRI±TB pathway is superior to TRUS biopsy in detecting csPCa and avoiding the diagnosis of cisPCa. MRI should be included in the standard of care pathway for prostate cancer diagnosis.
Methods: MEDLINE, EMBASE, Web of Science, Cochrane Central of Registered Trials and ClinicalTrials.gov were searched on the 12th November 2023 for randomised controlled trials of biopsy-naïve patients with clinical suspicion of PCa undergoing MRI or standard TRUS. Studies were included if those with suspicious MRI underwent targeted biopsy alone, and those with non-suspicious lesion avoided biopsy. Primary outcome is the proportion of men diagnosed with csPCa (Gleason 3+4 or greater).
Key findings: Two studies, PRECISION and PRECISE (953 patients), were included in the IPDMA. In the MRI±TB arm, 32.2% of patients avoided biopsy due to non-suspicious MRI. MRI±TB detected 8.7 percentage points (36.3% vs 27.6%; 95%CI 2.8 to 14.6, p=0.004) more csPCa in comparison to TRUS biopsy and 12.3 percentage points (9.6% vs 21.9%; 95%CI 7.8 to 16.9, p<0.001) less clinically insignificant cancer (cisPCa; Gleason 3+3). The overall risk of bias for the included studies were found to be low after assessment using the QUADAS-2, QUADAS-C and ROB 2.0 tools.
Conclusion: The MRI±TB pathway is superior to TRUS biopsy in detecting csPCa and avoiding the diagnosis of cisPCa. MRI should be included in the standard of care pathway for prostate cancer diagnosis.
| Original language | English |
|---|---|
| Journal | European urology |
| Early online date | 3 Sept 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 3 Sept 2024 |
Keywords
- MRI
- PRECISION
- prostate cancer
- Prostate Biopsy
- Targeted Biopsy
- TRUS Biopsy
