Editing Prostate Cancer: Diagnosis and evaluation (section)

====== <span style="color:#ff0000">Test Characteristics ======

* '''<span style="color:#ff00ff">Cochrane Systematic Review and Meta-analysis (2019)</span>'''
** '''MRI compared with template‐guided biopsy'''
***'''Detection of grade 2 or higher prostate cancer'''
****'''Sensitivity: 0.91 (95% CI 0.83 to 0.95)'''
****'''Specificity: 0.37 (95% CI 0.29 to 0.46)'''
***'''Detection of grade 3 or higher prostate cancer'''
****'''Sensitivity: 0.95 (95% CI 0.87 to 0.99)'''
****'''Specificity: 0.35 (95% CI 0.26 to 0.46)'''
**[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483565/ Drost, Frank‐Jan H., et al.] "Prostate MRI, with or without MRI‐targeted biopsy, and systematic biopsy for detecting prostate cancer." ''Cochrane Database of Systematic Reviews'' 4 (2019).
*'''<span style="color:#ff00ff">PROMIS (2017)</span>'''
** '''<span style="color:#ff0000">Objective: evaluate sensitivity/specificity of prostate MRI vs. standard TRUS biopsy,</span> with template prostate mapping biopsy as gold standard reference'''
** Population: 576 men with a clinical suspicion of prostate cancer (elevated serum PSA (up to 15 ng/mL) within previous 3 months, suspicious digital rectal examination, suspected organ confined stage T2 or lower on rectal examination, or family history) and no previous prostate biopsy
** '''Intervention: prostate MRI followed by template prostate mapping biopsy as gold standard reference and then standard TRUS biopsy'''
***MRI was done with 1.5 Tesla magnet
***Patients with positive MRI did not undergo targeted biopsy
** Primary outcomes: sensitivity and specificity of prostate MRI vs. standard TRUS biopsy for detection of clinically significant prostate cancer
***Clinically significant prostate cancer defined as Gleason score ≥4 + 3 or a maximum cancer core length 6 mm or longer
**'''<span style="color:#ff0000">Results:</span>'''
*** '''<span style="color:#ff0000">mpMRI displayed a moderate sensitivity</span>''' (88%) and negative predictive value (76%), '''<span style="color:#ff0000">but poor specificity</span>''' (45%) and positive predictive value (65%).
**Authors' interpretation: MP-MRI, used as a triage test before first prostate biopsy, could reduce unnecessary biopsies by ≈25% (based on negative-predictive value). MP-MRI can also reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.
**[https://pubmed.ncbi.nlm.nih.gov/28110982/ Ahmed, Hashim U., et al.] "Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study." The Lancet 389.10071 (2017): 815-822.