Brachytherapy for Prostate Cancer 2017

Can clinically significant prostate cancer be detected with multipara- metric magnetic resonance imaging? A systematic review of the literature. Fütterer JJ et al., Eur Urol 2015; Epub ahead of print been shown that multiparametric magnetic resonance imaging (mpMRI) facilitates tion of PCa and can help in targeting prostate biopsy. Objective: To systematically review the literature to determine the diagnostic accuracy

localisa-

of

mpMRI

in

the detection

of

clinically

significant

PCa.

Evidenceacquisition:

ThePubmed,Embase,andCochraneCentral Register of ControlledTrials

(CENTRAL) databases were searched the search criteria‘‘prostateORPcaORPSAORprostaticORprostatecancer’’ AND‘‘MRORNMROR NMRI ORMRI ORmagnetic resonance ORADCORDWI ORDCEORdiffusion weighted OR dynamiccontrast ORmultiparametricORMRSI ORMRspectroscopy’’. Two reviewersindepen- dently assessed 1729 records. Two independent reviewersassessed themethodologic quality using theQuality 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), amedian prostate-specific antigen (PSA) level of 5.1–13.4 ng/ml (range1.2–228 ng/ml), and Gleason scoreof 6–10. Variousdefini tions 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 PCausingmpMRI ranged from 44% to 87%in biopsy-naı¨vemales 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 isabletodetect significant PCain biopsy-naı¨vemalesandmenwith prior negativebiopsies. Thenegativepredictivevalueof mpMRI is important to theclinician because mpMRI couldbeused toruleout significant disease.Thismay result in fewer or nosystematicor targeted biopsies in patientswith PSAsuspicious for prostate cancer. Patient summary: We reviewed the diagnostic accuracy of multiparametric magnetic reso- from January 1, 2000 to September 30, 2014, using

ith

atic

illeirs c ,

earch IRCCS of Urology, University artment of Radiology, r, New York, NY, USA; rology, LilleUniversity Institute,

jor

challenge.

It

has

)

facilitates

localisa-

gnostic accuracy

of

r of Controlled Trials 30, 2014, using the ND‘‘MRORNMROR fusion weighted OR reviewersindepen- ethodologic quality ) 2 tool. ad a median age of el of 5.1–13.4 ng/ml clinical significance t biopsy, number of RI ranged from 44% g prostate biopsy or