Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

摘要: Abstract Context Recent studies suggested that magnetic resonance imaging (MRI) followed by targeted biopsy (“MRI-stratified pathway”) detects more clinically significant prostate cancers (csPCa) than the systematic transrectal ultrasound-guided (TRUS-Bx) pathway, but controversy persists. Several randomized clinical trials (RCTs) were recently published, enabling generation of higher-level evidence to evaluate this hypothesis. Objective To perform a review and meta-analysis RCTs comparing detection rates csPCa in MRI-stratified pathway TRUS-Bx patients with suspicion cancer (PCa). Evidence acquisition PubMed, EMBASE, Cochrane databases searched up March 18, 2019. reporting both pathways included. Relative pooled using random-effect model. Study quality was assessed risk bias tool for trials. A comparison insignificant PCa (cisPCa) any also performed. synthesis Nine (2908 patients) The detected (relative rate 1.45 [95% confidence interval {CI} 1.09–1.92] all patients, 1.42 CI 1.02–1.97] 1.60 1.01–2.54] biopsy-naive prior negative respectively). Detection not significantly different between cisPCa (0.89 0.49–1.62]), higher (1.39 1.05–1.84]). Conclusions TRUS-guided men PCa, those biopsy. from cisPCa. Patient summary Our shows imaging-stratified cancer.