Methodological considerations in assessing the utility of imaging in early prostate cancer

Purpose of review An imaging-based pathway, including multiparametric MRI (mpMRI) and magnetic resonance (MR) targeted biopsy, is being increasingly proposed to overcome the shortcomings of the current pathway, based on transrectal ultrasound (TRUS) random biopsy. The purpose of this review is to look at the methodological considerations that need to be addressed prior to widespread adoption of this pathway. Recent findings Novel diagnostic tests should be evaluated in a stepwise fashion with respect to key points: technical accuracy, place in the clinical pathway, diagnostic accuracy, impact on patient outcome and cost-effectiveness. The combination of mpMRI and MR-targeted biopsy has been shown to be superior to TRUS biopsy with regard to most of these key points. mpMRI has the characteristics to be employed as a triage test. MR-targeted biopsy has been consistently shown to be superior to TRUS biopsy in terms of detection of clinically significant disease, utility and efficiency. Before widespread adoption, it is essential to standardize these tests and verify the reproducibility of their performance. Summary Comparative diagnostic studies are consistently in favour of an imaging-based pathway. Once standardization and reproducibility will be verified, it is likely that TRUS biopsy will be implemented, or replaced by mpMRI and MR-targeted biopsy.

[1]  J. Fütterer,et al.  Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature. , 2015, European urology.

[2]  D. Nieboer,et al.  Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. , 2015, European urology.

[3]  Pierre Mozer,et al.  Detection of Clinically Significant Prostate Cancer Using Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy: A Systematic Review. , 2015, European urology.

[4]  P. Acher,et al.  Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI‐RADS) scoring in a transperineal prostate biopsy setting , 2015, BJU international.

[5]  R. Gabe,et al.  PROMIS — Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer☆ , 2015, Contemporary clinical trials.

[6]  Baris Turkbey,et al.  Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. , 2015, JAMA.

[7]  Heinz-Peter Schlemmer,et al.  Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. , 2015, The Journal of urology.

[8]  Geoffrey A. Sonn,et al.  Initial experience with electronic tracking of specific tumor sites in men undergoing active surveillance of prostate cancer. , 2014, Urologic oncology.

[9]  D. Moses,et al.  Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study. , 2014, The Journal of urology.

[10]  Ian A. Donaldson,et al.  Multiparametric MRI followed by targeted prostate biopsy for men with suspected prostate cancer: a clinical decision analysis , 2014, BMJ Open.

[11]  S. Vowler,et al.  Identification of pathologically insignificant prostate cancer is not accurate in unscreened men , 2014, British Journal of Cancer.

[12]  H. Ahmed,et al.  Prostate Cancer Risk Inflation as a Consequence of Image-targeted Biopsy of the Prostate: A Computer Simulation Study , 2014, European urology.

[13]  Emily Vertosick,et al.  The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance. , 2014, The Journal of urology.

[14]  M Emberton,et al.  Performance of multiparametric MRI in men at risk of prostate cancer before the first biopsy: a paired validating cohort study using template prostate mapping biopsies as the reference standard , 2013, Prostate Cancer and Prostatic Disease.

[15]  M. Roethke,et al.  Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla , 2014, European Radiology.

[16]  H. Ahmed,et al.  Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. , 2013, The Journal of urology.

[17]  Raj Persad,et al.  Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway? , 2013, Journal of magnetic resonance imaging : JMRI.

[18]  Mark Emberton,et al.  Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. , 2013, European urology.

[19]  J. Fütterer,et al.  ESUR prostate MR guidelines 2012 , 2012, European Radiology.

[20]  E. Burnside,et al.  The ACR BI-RADS experience: learning from history. , 2009, Journal of the American College of Radiology : JACR.

[21]  D. Ramaekers,et al.  The evaluation of diagnostic tests: evidence on technical and diagnostic accuracy, impact on patient outcome and cost-effectiveness is needed. , 2007, Journal of clinical epidemiology.

[22]  Paul Glasziou,et al.  Comparative accuracy: assessing new tests against existing diagnostic pathways , 2006, BMJ : British Medical Journal.

[23]  D. Beyersdorff,et al.  Differentiation of prostate cancer from normal prostate tissue in an animal model: conventional MRI and dynamic contrast-enhanced MRI. , 2005, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[24]  E. Atalar,et al.  Phased‐array MRI of canine prostate using endorectal and endourethral coils , 2003, Magnetic resonance in medicine.

[25]  J Kurhanewicz,et al.  Magnetic resonance spectroscopy in prostate disease: Diagnostic possibilities and future developments , 1992, The Prostate. Supplement.