The PRECISION and PRECISE trials compared magnetic resonance imaging targeted biopsy (MRI ± TB) with the standard transrectal ultrasound (TRUS) guided biopsy for the detection of clinically significant prostate cancer (csPCa). PRECISION demonstrated superiority of MRI ± TB over TRUS guided biopsy, while PRECISE demonstrated noninferiority. The VISION study is a planned individual patient data meta-analysis (IPDMA) comparing MRI ± TB with TRUS guided biopsy for csPCa diagnosis.
MEDLINE, EMBASE, Web of Science, Cochrane Central of Registered Trials, and ClinicalTrials.gov were searched on the November 12, 2023 for randomised controlled trials of biopsy-naïve patients with a clinical suspicion of prostate cancer undergoing MRI or standard TRUS. Studies were included if its participants with suspicious MRI underwent targeted biopsy alone and those with nonsuspicious lesion avoided biopsy. The primary outcome is the proportion of men diagnosed with csPCa (Gleason ≥3 + 4).
Two studies, PRECISION and PRECISE (953 patients), were included in the IPDMA. In the MRI ± TB arm, 32.2% of patients avoided biopsy due to nonsuspicious MRI. MRI ± TB detected 8.7 percentage points (36.3% vs 27.6%; 95% confidence interval [CI] 2.8-14.6, p = 0.004) more csPCa than TRUS biopsy and 12.3 percentage points (9.6% vs 21.9%; 95% CI 7.8-16.9, p < 0.001) less clinically insignificant prostate cancer (cisPCa; Gleason 3 + 3). The overall risk of bias for the included studies were found to be low after assessment using the QUADAS-2, QUADAS-C, and ROB 2.0 tools.
The MRI ± TB pathway is superior to TRUS biopsy in detecting csPCa and avoiding the diagnosis of cisPCa. MRI should be included in the standard of care pathway for prostate cancer diagnosis.
European urology. 2024 Sep 03 [Epub ahead of print]
Veeru Kasivisvanathan, Vinson Wai-Shun Chan, Keiran D Clement, Brooke Levis, Alexander Ng, Aqua Asif, Masoom A Haider, Mark Emberton, Gregory R Pond, Ridhi Agarwal, Katie Scandrett, Yemisi Takwoingi, Laurence Klotz, Caroline M Moore, VISION Study Collaborators
Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK. Electronic address: ., Division of Surgery and Interventional Sciences, University College London, London, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK., Department of Urology, NHS Greater Glasgow & Clyde, Glasgow, UK., Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK., Division of Surgery and Interventional Sciences, University College London, London, UK., Sinai Health System Toronto, Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK; NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK., Department of Oncology, McMaster University, Hamilton, Ontario, Canada., Department of Applied Health Sciences, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK., Department of Applied Health Sciences, University of Birmingham, Birmingham, UK., Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.