Magnetic Resonance Imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis

Research output: Contribution to journalArticle


  • Veeru Kasivisvanathan
  • Armando Stabile
  • Joana B. Neves
  • Francesco Giganti
  • Massimo Valerio
  • Yaalini Shanmugabavan
  • Keiran D. Clement
  • Debashis Sarkar
  • Yiannis Philippou
  • David Thurtle
  • Mark Emberton
  • Caroline M. Moore

Colleges, School and Institutes

External organisations



Context: MRI-targeted prostate biopsy (MRI-TB) may be an alternative to systematic biopsy for diagnosing prostate cancer.

Objective: The primary aims of this systematic review and meta-analysis were to compare the detection rates of clinically significant and clinically insignificant cancer by MRI-TB to systematic biopsy in men undergoing prostate biopsy to identify prostate cancer.

Evidence acquisition: A literature search was conducted using the PubMed, Embase, Web of Science, Cochrane library and databases. We included prospective and retrospective paired studies where the index test was MRI-TB and the comparator test was systematic biopsy. We also included randomized controlled trials (RCTs) if one arm included MRI-TB and another arm included systematic biopsy. The risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. In addition, the Cochrane risk of bias 2.0 tool was used for RCTs.

Evidence Synthesis: We included 68 studies with a paired design and 8 RCTs, comprising a total of 14709 men who received either both MRI-TB and systematic biopsy or were randomized to receive one of the tests.MRI-TB detected more men with clinically significant cancer than systematic biopsy (Detection ratio (DR) 1.16 [95% CI 1.09-1.24], p < 0.0001) and fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57-0.76], p < 0.0001). The proportion of cores positive for cancer was greater for MRI-TB than systematic biopsy, relative risk 3.17 [95% CI 2.82-3.56], p<0.0001.

Conclusions: MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy.

Patient summary:We evaluated the published literature, comparing two methods of diagnosing prostate cancer. We found that biopsies targeted to suspicious areas on an MRI (MRI-Targeted biopsy) were better at detecting prostate cancer that needs to be treated and at avoiding the diagnosis of disease that doesn’t need treatment than the traditional systematic biopsy.


Original languageEnglish
Pages (from-to)284-303
JournalEuropean urology
Issue number3
Early online date24 May 2019
Publication statusPublished - Sep 2019


  • MRI-targeted biopsy, systematic biopsy, prostate cancer, diagnosis, clinically significant, clinically insignificant, meta-analysis, systematic review