Should men undergo MRI before prostate biopsy-CON

Prostate magnetic resonance imaging (MRI) is increasingly used prior to biopsy in response to the overdiagnosis and overtreatment of prostate cancer (CaP) associated with prostate-specific antigen (PSA) based screening. However, technical limitations in the conventional diffusion-weighted imaging (DWI) sequences as well as the high degree of radiologist-to-radiologist variability in interpreting prostate MRI result in inadequate accuracy. Specifically, the insufficient negative predictive value (NPV) of prostate MRI (76%-87%) does not allow biopsy to be omitted in the negative MRI setting. Additionally, the variable, and relatively low positive predictive value (PPV) of MRI (27%-44%) provides only an incremental improvement in risk prediction compared to readily available clinical tools such as the Prostate Cancer Prevention Trial risk calculator. This small benefit is likely confined to the minority of patients with positive MRI findings in a typically under-sampled region of the prostate (e.g., anterior lesions), which may be obviated by newer biopsy approaches and tools such as transperineal prostate biopsy and micro-ultrasound technology. With these considerations in mind, pre-biopsy prostate MRI in its current form is unlikely to provide a clinically significant benefit, and should not be considered as routine practice until its accuracy is sufficiently improved. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

Prostate magnetic resonance imaging (MRI) is commonly used before biopsy to address the issues of overdiagnosis and overtreatment associated with PSA-based screening for prostate cancer (CaP). However, the accuracy of prostate MRI is limited due to technical constraints and inter-observer variability, leading to inadequate negative predictive value (NPV) and relatively low positive predictive value (PPV). The current form of pre-biopsy prostate MRI does not provide a clinically significant benefit and should not be considered routine practice until its accuracy is improved.