Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies

Ugo Giovanni Falagario; Francesco Pellegrino; Antonio Fanelli; Francesco Guzzi; Riccardo Bartoletti; Hannes Cash; Christian Pavlovich; Mark Emberton; Giuseppe Carrieri; Gianluca Giannarini

doi:10.1038/s41391-024-00827-x

Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies

Prostate Cancer Prostatic Dis. 2024 Apr 5. doi: 10.1038/s41391-024-00827-x. Online ahead of print.

Authors

Affiliations

¹ Department of Molecular Medicine and Surgery, (Solna), Karolinska Institutet, Stockholm, Sweden. [email protected].
² Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy. [email protected].
³ Unit of Urology/Division of Oncology, Soldera Prostate Cancer Lab, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
⁴ Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy.
⁵ Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
⁶ Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
⁷ PROURO, Berlin, Germany.
⁸ James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Division of Surgery and Interventional Sciences, University College London, London, UK.
¹⁰ Department of Urology, University College London Hospital, London, UK.
¹¹ Urology Unit, Santa Maria Della Misericordia University Hospital, Udine, Italy.

PMID: 38580833
DOI: 10.1038/s41391-024-00827-x

Abstract

Background: Three primary strategies for MRI-targeted biopsies (TB) are available: Cognitive TB (COG-TB), MRI-US Fusion TB (FUS-TB), and In Bore TB (IB-TB). Despite nearly a decade of practice, a consensus on the preferred approach is lacking, with previous studies showing comparable PCa detection rates among the three methods.

Methods: We conducted a search of PubMed, EMBASE, PubMed, Web of Science, and Scopus databases from 2014 to 2023, to identify studies comparing at least two of the three methods and reporting clinically significant PCa (csPCa) detection rates. The primary and secondary outcomes were to compare the csPCa and insignificant prostate cancer (iPCa, ISUP GG 1) detection rates between TB techniques. The tertiary outcome was to compare the complication rate between TB techniques. Detection rates were pooled using random-effect models. Planned sensitivity analyses included subgroup analysis according to the definition of csPCa and positive MRI, previous biopsy status, biopsy route, prostate volume, and lesion characteristics.

Results: A total of twenty studies, involving 4928 patients, were included in the quantitative synthesis. The meta-analysis unveiled comparable csPCa detection rates among COG-TB (0.37), FUS-TB (0.39), and IB-TB (0.47). iPCa detection rate was also similar between TB techniques (COG-TB: 0.12, FUS-TB: 0.17, IB-TB: 0.18). All preplanned sensitivity analyses were conducted and did not show any statistically significant difference in the detection of csPCa between TB methods. Complication rates, however, were infrequently reported, and when available, no statistically significant differences were observed among the techniques.

Conclusions: This unique study, exclusively focusing on comparative research, indicates no significant differences in csPCa and iPCa detection rates between COG-TB, FUS-TB, and IB-TB. Decisions between these techniques may extend beyond diagnostic accuracy, considering factors such as resource availability and operator preferences. Well-designed prospective studies are warranted to refine our understanding of the optimal approach for TB in diverse clinical scenarios.

Publication types

Review