Multiparametric magnetic resonance imaging (mpMRI) with informed targeted biopsies (TGBX) has changed the paradigm of prostate cancer (PCa) diagnosis. Randomized studies have demonstrated a diagnostic benefit of Clinically significant (CS) for TGBX compared to standard systematic biopsies (SBX). We aimed to evaluate whether mpMRI-informed TGBX has superior diagnosis rates of any-, CS-, high-grade (HG)-, and clinically insignificant (CI)-PCa compared to SBX in biopsy-naive men.

Data was searched in Medline, Embase, Web of Science, and Evidence-based medicine reviews-Cochrane Database of systematic reviews from database inception until 2019. Studies were selected by two authors independently, with disagreements resolved by consensus with a third author. Overall 1951 unique references were identified, and 100 manuscripts underwent full-text review. Data were pooled using random-effects models. The meta-analysis is reported according to the PRISMA statement. The study protocol is registered with PROSPERO (CRD42019128468).

Overall 29 studies (13,845 patients) were analyzed. Compared to SBX, use of mpMRI-informed TGBX was associated with a 15% higher rate of any PCa diagnosis (95% CI 10-20%, p<0.00001). This relationship was not affected by the study methodology (p=0.11). Diagnosis of CS and HG PCa were more common in the mpMRI-informed TGBX group (risk difference of 11%, 95% CI 0-20%, p=0.05, and 2%, 95% CI 1-4%; p=0.005, respectively) while there was no difference in diagnosis of CI PCa (risk difference of 0, 95% CI -3 to 3%, p=0.96). Notably, the exclusion of SBX in the mpMRI-informed TGBX arm significantly modified the association between a mpMRI strategy and lower rates of CI PCa diagnosis (p=0.01) without affecting the diagnosis rates of CS- or HG-PCa.

In comparison to SBX, a mpMRI-informed TGBX strategy results in a significantly higher diagnosis rate of any-, CS-, and HG-PCa. Excluding SBX from mpMRI-informed TGBX was associated with decreased rates of CI-PCa diagnosis without affecting diagnosis of CS- or HG-PCa.

The Journal of urology. 2019 Oct 14 [Epub ahead of print]

Hanan Goldberg, Ardalan E Ahmad, Thenappan Chandrasekar, Laurence Klotz, Mark Emberton, Masoom A Haider, Samir S Taneja, Karan Arora, Neil Fleshner, Antonio Finelli, Nathan Perlis, Mark D Tyson, Zachary Klaassen, Christopher J D Wallis

Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada., Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia Pennsylvania., Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Division of Surgery and Interventional Science, University College London, London, United Kingdom., Department of Medical Imaging, Princess Margaret Cancer Center, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Ontario, Canada., Department of Urology and Radiology, NYU Langone Health, New York., Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona., Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia.