Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature

Context: Detection of clinically significant prostate cancer (PCa) is a major challenge. It has been shown that multiparametric magnetic resonance imaging (mpMRI) facilitates localisation of PCa and can help in targeting prostate biopsy. Objective: To systematically review the literature to determine the diagnostic accuracy of mpMRI in the detection of clinically significant PCa. Evidence acquisition: The Pubmed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from January 1, 2000 to September 30, 2014, using the search criteria prostate OR Pca OR PSA OR prostatic OR prostate cancer'' AND MR OR NMR OR NMRI OR MRI OR magnetic resonance OR ADC OR DWI OR DCE OR diffusion weighted OR dynamic contrast OR multiparametric OR MRSI ORMR spectroscopy''. Two reviewers independently assessed 1729 records. Two independent reviewers assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) 2 tool. Evidence synthesis: Twelve articles were eventually selected. Patients had a median age of 62-65 yr (range 39-83 yr), a median prostate-specific antigen (PSA) level of 5.1-13.4 ng/ml (range 1.2-228 ng/ml), and Gleason score of 6-10. Various definitions of clinical significance were used, mainly based on maximum cancer core length and grade at biopsy, number of positive cores, and PSA. Detection of clinically significant PCa using mpMRI ranged from 44% to 87% in biopsy-naive males and men with prior negative biopsies using prostate biopsy or definitive pathology of a radical prostatectomy specimen as the reference standard. The negative predictive value for exclusion of significant disease ranged from 63% to 98%. Conclusions: mpMRI is able to detect significant PCa in biopsy-naive males and men with prior negative biopsies. The negative predictive value of mpMRI is important to the clinician because mpMRI could be used to rule out significant disease. This may result in fewer or no systematic or targeted biopsies in patients with PSA suspicious for prostate cancer. Patient summary: We reviewed the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (PCa). We conclude that mpMRI is able to detect significant PCa and may used to target prostate biopsies. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.