CPD: Prostate Cancer

Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis

AUTHOR: E. J. Bass, A. Pantovic, M. J. Connor, S. Loeb, A. R. Rastinehad, M. Winkler, Rhian Gabe & H. U. Ahmed

Multiparametric MRI localizes cancer in the prostate, therefore allowing for MRI guided biopsy (MRIGB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRIGB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and lastly MRI ‘in-bore’ biopsy (IB-TB). Although it is unknown whether any of these are superior.

1. REFLECT – Before reading this module, consider the following: Will this clinical area be relevant to my practice?

2. IDENTIFY – If the answer is no, I may still be interested in the area. However, the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should therefore identify any knowledge gaps in the clinical area.

3. PLAN – If I have identified a knowledge gap – will this article satisfy those needs? Will more reading be required in addition to this?

4. EVALUATE – Did this article meet my learning needs – and in addition to this how has my practise changed as a result? Have I identified further learning needs?

5. WHAT NEXT – At this time you may like to record your learning for future use or assessment.

Lastly, follow the 4 previous steps, log and record your findings.

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60 Second Summary on Prostate Cancer CPD:

We conducted a systematic review and meta-analysis to address three questions. Firstly, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Secondly, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Thirdly and lastly, whether any MRI-GB strategy is superior at detecting csPCa.

A systematic literature review from 2015 to 2019 was performed in accordance with the START recommendations. Studies reporting PCa detection rates, employing MRI-GB and TRUSGB were included and evaluated using the QUADAS-2 checklist. 1553 studies were found, of which 43 were included in the meta-analysis.

For csPCa, MRI-GB was superior in detection to TRUS-GB (0.83 vs. 0.63 [p = 0.02]). MRI-GB was superior in detection to TRUS-GB at avoiding detection of insignificant PCa. No MRIGB technique was superior at detecting csPCa (IB-TB 0.87; COG TB 0.81; FUS-TB 0.81, [p = 0.55]). Observed was significant heterogeneity between the included studies.

In patients with suspected PCa on MRI, MRI-GB offers superior rates of csPCa detection. It reduces detection of insignificant PCa compared to TRUS-GB. In addition to this no individual MRI-GB technique was found to be better in csPCa detection. Prospective adequately powered randomized controlled trials are required.

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