Journal
PROSTATE CANCER AND PROSTATIC DISEASES
Volume 22, Issue 2, Pages 235-243Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/s41391-018-0111-4
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Funding
- National Key research and development program of China [2017YFC0908003]
- Tibetan Natural Science Foundation [XZ2017ZR-ZY019]
- Youth clinical research project of Peking University First Hospital [2017CR07]
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Background The contemporary active surveillance (AS) criteria may result in an unsatisfactory misclassification rate, which may delay curative treatment for prostate cancer patients. The magnetic resonance imaging (MRI), not included in any AS criteria, provides useful information for prostate cancer diagnosis. Our goal is to evaluate the diagnostic performance of Prostate Imaging Reporting and Data Systems (PI-RADS) score, a standardized MRI reporting system, in AS candidates enrollment. Methods We searched Cochrane CENTRAL, PubMed, and Embase for pertinent studies through June 2018. The standard methods recommended for meta-analyses of diagnostic evaluation were employed. We draw the summary receiver operating characteristic (SROC) curve. Meta-regression analysis was performed to evaluate the effects of confounding factors. Results From the resulting 168 studies, 5 provided the diagnostic data on PI-RADS score and pathological results; 834 patients were included. All AS candidates in these studies were defined by Prostate Cancer Research International: Active Surveillance (PRIAS) criterion. The pooled estimates of PI-RADS 4 or 5 on adverse pathological features at radical prostatectomy (RP) among AS candidates were: sensitivity, 0.77 (95% confidence interval (CI), 0.71-0.82); specificity, 0.63 (95% CI, 0.55-0.71); positive predictive value, 0.72 (95% CI, 0.64-0.79); negative predictive value, 0.68 (95% CI, 0.63-0.73); and diagnostic odds ratio, 6 (95% CI, 4-8). The SROC curve was positioned toward the desired upper left corner of the curve, the area under the curve was 0.77 (95% CI, 0.73-0.80). The P-value for heterogeneity was <0.01. The pathological outcomes and endorectal coils contributed to the heterogeneity of sensitivity. The evidences supporting the advantage of PI-RADS v2 over v1 were not sufficient yet. Conclusion AS candidates with PI-RADS 4 or 5 may be unsuitable for AS even though they fulfill current AS criteria. Those with PI-RADS 3 or less indicated relative safety for AS enrollment.
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