MRI-GB vs TRUS-GB: Who can locate prostate cancer lesions more accurately?

The editor commented that prostate cancer (PCa) is the second most common malignant tumor in men in the world.
There are often no obvious symptoms in the early stage.
When the patient is discovered, it is usually in the advanced stage, and the best time for treatment has been lost
.

Therefore, early screening, early diagnosis, and early treatment are one of the keys to improving the five-year survival rate of prostate cancer patients
.

At present, in clinical practice, when the digital rectal examination (DRE) results are abnormal or the prostate specific antigen (PSA) is elevated, prostate cancer can be suspected, and auxiliary imaging methods are needed to confirm the diagnosis
.

Magnetic resonance-guided prostate biopsy (MRI-GB) and transrectal ultrasound-guided prostate biopsy (TRUS-GB) are currently more common methods for locating prostate cancer lesions [1]
.

So, in the detection of PCa, which method is better, MRI-GB or TRUS-GB? Recently, a retrospective analysis published in Nature's journal, prostate cancer and prostatic diseases, discussed this issue
.

Study Introduction This study used a systematic review and meta-analysis to explore three questions: first, whether the detection rate (CDR) of MRI-GB for clinically significant prostate cancer (csPCa) is better than TRUS-GB; second, Whether MRI-GB is better than TRUS-GB in avoiding the detection of PCa that is of no clinical significance; third, among the common MRI-GB strategies, cognitive fusion targeted puncture (COG-TB) and image fusion targeted puncture ( FUS-TB) and In-bore MRI-guided biopsy (IB-TB), which is the better strategy
.

The study conducted a systematic review of the literature from December 15, 2015 to July 29, 2019.
A total of 1,553 studies using MRI-GB and TRUS-GB to report PCa detection rates were retrieved, and 43 of them were included in the meta-analysis Analysis (Figure 1)
.

Figure 1 Research selection process.
Research results 01MRI-GB is better than TRUS-GB for csPCa CDR? There is a statistically significant difference in the sensitivity of MRI-GB and TRUS-GB to csPCa, with a relative CDR of 1.
24 [95%CI 1.
03-1.
50, p=0.
02], but there is significant heterogeneity between the studies (I2 = 95.
9%) (Figure 2)
.

The combined CDRs of MRI-GB and TRUS-GB were 0.
83[95%CI 0.
76–0.
90] and 0.
63[95%CI 0.
53–0.
74], respectively
.

There is a significant difference in heterogeneity between the two, MRI-GB is 83.
7%, TRUS-GB is 97.
7%
.

Figure 2 The detection rate of csPCa 02 is whether MRI-GB is better than TRUS-GB in avoiding the detection of non-clinically significant PCa? The results showed that the CDR of MRI-GB for PCa that is not clinically significant is lower than that of TRUS-GB, respectively 0.
08 [95%CI 0.
06-0.
11] (I2=93.
1%) and 0.
15 [95%CI 0.
12-0.
17] (I2 =92.
7%)
.

The combined analysis showed that MRI-GB has a more significant advantage in avoiding the detection of non-clinically significant PCa (p<0.
0001), the combined relative diagnosis rate was 0.
58 [0.
46-0.
74], and the study heterogeneity was 63.
3% (Figure 3)
.

Figure 3 The detection rate of non-clinically significant PCa 03 Which MRI-GB strategy is better? When the three MRI-GB techniques detect csPCa (p=0.
55), the combined CDR of IB-TB is 0.
87[95%CI 0.
81-0.
93], COG-TB is 0.
81[95%CI 0.
69-1.
03], FUS-TB It was 0.
81 [95%CI 0.
73-0.
91], and there was no statistically significant difference between the three
.

At the same time, there was no statistical difference between the three techniques in detecting PCa with no clinical significance (p=0.
46); the combined relative diagnosis rate of IB-TB was 0.
10[95%CI 0.
03–0.
31]; COG-TB 0.
05[95%CI 0.
02–0.
11], FUS-TB 0.
08[95%CI 0.
06–0.
11]
.

Therefore, the detection rate of csPCa has nothing to do with which MRI-GB strategy is adopted
.

Summary Based on the above research results, this retrospective analysis points out the following three points: 1.
MRI-GB is better than TRUS-GB in the detection rate of csPCa; 2.
In the detection of non-clinically significant PCa, MRI-GB and TRUS- There is no significant difference in GB; 3.
The three common clinical MRI-GB detection strategies have no statistical difference in the detection of csPCa
.

In addition, a study published in Diagn Interv Radiol in 2015 also pointed out that compared with TRUS-GB, MRI-GB has fewer side effects when detecting PCa, and the pain intensity suffered by patients is also lower [ 2] Therefore, we recommend MRI-GB as the first choice when locating prostate cancer lesions
.

References: [1] Bass, EJ, Pantovic, A.
, Connor, MJ et al.
Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis.
Prostate Cancer Prostatic Dis (2021).
[2] Egbers N, Schwenke C, Maxeiner A.
et al.
MRI-guided core needle biopsy of the prostate: acceptance and side effects.
Diagn Interv Radiol.
2015;21(3):215-221 .