Key clinical point: Biopsy-naive men with suspected prostate cancer who underwent a multiparametric (mp) magnetic resonance imaging (MRI)-targeted biopsy with or without systematic biopsy had a significantly higher detection rate of any-grade and high-grade cancer vs systematic biopsy alone.

Major finding: Compared with systematic biopsy, the use of mpMRI-targeted biopsy was associated with a 15% higher rate of any prostate cancer diagnosis (P less than .00001) and a 2% higher rate of high-grade cancer diagnosis (P = .005).

Study details: A meta-analysis of 29 studies including 13,845 biopsy-naive patients with suspected prostate cancer.

Disclosures: The study was supported by the United Kingdom National Institute for Health Research. The authors declared no conflicts of interest.

Commentary

“Accurate tissue diagnosis is of critical importance for appropriate treatment of prostate cancer. Systematic biopsy has been the standard approach for years, but as opposed to biopsy of most solid tumors, needle placement is not strictly based on identification of a suspicious lesion. Magnetic resonance imaging (MRI) to guide biopsy has been evaluated in randomized trials and observational studies. The systematic review and meta-analysis by Goldberg et al. evaluated whether an MRI approach had superior diagnosis rates compared with systematic biopsy. The MRI approach was associated with a higher rate of any prostate cancer diagnosis, a higher rate of clinically significant and higher risk prostate cancer diagnosis, but no significant difference in clinically insignificant prostate cancer diagnosis. While the results further support use of MRI, lack of standardization of MRI-based biopsy procedures has precluded a consensus for this recommendation amongst urologic societies.”

Mark Klein, MD