Comparing the Effectiveness of MRI-Guided Versus Ultrasound-Guided Biopsies in the Detection of Prostate Cancer

Abstract

Objective: Through a comprehensive systematic review and meta-analysis, this research sought to assess the diagnostic accuracy of MRI-guided prostate biopsies and ultrasound-guided prostate biopsies in the detection of prostate cancer. The research questions examined whether MRI-guided targeted biopsies improve detection of clinically significant prostate cancer (csPCa) and overall prostate cancer in comparison to ultrasound-guided biopsies.

Methods: A comprehensive literature search was designed and conducted across multiple databases up to April 10, 2023, to identify relevant randomised controlled trials (RCTs) published between 2019 and 2023. RCTs comparing MRI-guided targeted biopsy to ultrasound-guided systematic or cognitive biopsy were included. Outcomes analysed were rates of csPCa detection and overall prostate cancer detection. The calculation of pooled odds ratios was performed using fixed-effects models for data that showed homogeneity and random-effects models for data that exhibited heterogeneity. The assessment of bias was conducted via the Cochrane RoB 2.0 tool.

Results: Five RCTs with 1590 participants were included. A meta-analysis of three studies (n = 654) found MRI-guided biopsy significantly increased overall prostate cancer detection compared to ultrasound-guided biopsy (OR 1.93, 95% CI 1.40–2.68, p<0.0001). However, for csPCa detection specifically, MRI-guided biopsy showed a non-significant improvement over ultrasound-guided biopsy (OR 1.72, 95% CI 0.99–3.00, p = 0.06) based on three studies. Significant heterogeneity was present for csPCa detection (I² = 56%).

Conclusion: MRI-guided targeted biopsy appears to improve overall prostate cancer detection versus ultrasound-guided approaches. However, evidence remains inconclusive regarding its advantages for detecting clinically significant prostate cancer specifically. Additional high-quality RCTs are needed to clarify the comparative accuracy of these biopsy techniques for csPCa detection.