Login to Access Video or Poster Abstract: MP03-01
Sources of Funding: None

Introduction

The introduction of three kinds of magnetic resonance imaging-guided biopsies (MRI-GB) has changed the paradigm regarding prostate biopsies. Since whether to use MRI-GB and which technique should be preferred are still matters of controversy, we aimed to compare and rank prostate biopsy strategies.

Methods

We did a network meta-analysis to incorporate both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Scopus, Embase and the reference lists of relevant articles for randomised controlled trials published up to Sep 1, 2016, of different prostate biopsy strategies. The primary outcome was overall prostate cancer (PCa) detection rate. The secondary outcomes were clinically significant PCa (csPCa), clinically insignificant PCa (ciPCa) and positive core rate. We did pairwise meta-analyses by random effects model and network meta-analysis by Bayesian random effects model. We assessed the quality of evidence contributing to each network estimate using the GRADE framework. This study is registered with PROSPERO, number CRD42015026114.

Results

From a total of 3616 citations, 24 randomised trials with a total of 6 497 participants were included in this network meta-analysis. 11 prostate biopsy strategies published between 2000 and 2016 were considered. The quality of evidence was rated as low in most comparisons. Only for MRI-cognitive GB (Relative risk [RR] 2.66, 95% credible interval [CrI] 1.44-4.72) enough evidence existed to support superiority when compared with transrectal ultrasound(TRUS) (10-12)-GB. csPCa and ciPCa detection rate suggested no significant difference between any pair of groups for biopsy technique. In terms of positive core rate, MRI-cognitive was significantly effective than TRUS(10-12) (RR 4.32, 95% CrI 1.45-13.30), TPUS(10-12) (RR 4.55, 95% CrI 1.34-15.98) and TRUS(>12) PB (RR 4.80, 95% CrI 1.34-17.58). In the subgroup of patients ≥ 65 yr and PSA < 10 ng/ml, MRI/TRUS was significantly effective than TRUS(10-12) (RR 2.47, 95% CrI 1.30-4.75; RR 2.45, 95% CrI 1.20-5.09).

Conclusions

MRI-cognitive GB had better overall PCa detection rates compared with TRUS(10-12)-GB, but similar rates of csPCa and ciPCa.Nevertheless, doctors need to consider our results together with all known safety and economy information when selecting the strategy for individual patients. Head-to-head comparisons of MRI-GB techniques are limited and are needed to confirm our findings.

Funding

None