Abstract
Abstract
Objective
To investigate the diagnostic performance of MRI in detecting clinically significant prostate cancer (csPCa) and prostate cancer (PCa) in patients with prostate-specific antigen (PSA) levels of 4–10 ng/mL.
Methods
A computerized search of PubMed, Embase, Cochrane Library, Medline, and Web of Science was conducted from inception until October 31, 2023. We included articles on the use of MRI to detect csPCa or PCa at 4–10 ng/mL PSA. The primary and secondary outcomes were MRI performance in csPCa and PCa detection, respectively; the estimates of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were pooled in a bivariate random-effects model.
Results
Among the 19 studies (3879 patients), there were 10 (2205 patients) and 13 studies (2965 patients) that reported MRI for detecting csPCa or PCa, respectively. The pooled sensitivity and specificity for csPCa detection were 0.84 (95% confidence interval [CI], 0.79–0.88) and 0.76 (95%CI, 0.65–0.84), respectively, for PCa detection were 0.82 (95%CI, 0.75–0.87) and 0.74 (95%CI, 0.65–0.82), respectively. The pooled NPV for csPCa detection was 0.91 (0.87–0.93). Biparametric magnetic resonance imaging also showed a significantly higher sensitivity and specificity relative to multiparametric magnetic resonance imaging (both p < 0.01).
Conclusion
Prostate MRI enables the detection of csPCa and PCa with satisfactory performance in the PSA gray zone. The excellent NPV for csPCa detection indicates the possibility of biopsy decision-making in patients in the PSA gray zone, but substantial heterogeneity among the included studies should be taken into account.
Clinical relevance statement
Prostate MRI can be considered a reliable and satisfactory tool for detecting csPCa and PCa in patients with PSA in the “gray zone”, allowing for reducing unnecessary biopsy and optimizing the overall examination process.
Key Points
Prostate-specific antigen (PSA) is a common screening tool for prostate cancer but risks overdiagnosis.
MRI demonstrated excellent negative predictive value for prostate cancer in the PSA gray zone.
MRI can influence decision-making for these patients, and biparametric MRI should be further evaluated.
Graphical Abstract
Funder
Beijing natural Science Foundation
High-level Hospital Construction Project of Guangdong Provincial People’s Hospital
Chinese Academy of Medical Sciences Initiative for Innovative Medicine
Publisher
Springer Science and Business Media LLC