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Transperineal magnetic resonance imaging targeted biopsy versus transrectal route in the detection of prostate cancer: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Purpose

Magnetic resonance imaging (MRI) has deeply altered the prostate biopsy strategy to detect prostate cancer. However, it is still debatable whether the detection rate differs between transrectal (TR) and transperineal (TP) MRI-targeted biopsy (MRI-TB). To compare the effectiveness of these two methods for detecting both overall prostate cancer (PCa) and clinically significant PCa (csPCa), We performed a review and meta-analysis.

Methods

Until January 2023, we conducted a thorough search of Cochrane, Embase, Ovid, and PubMed. In total, 1482 references were identified, and 15 records were finally included. For PCa and csPCa discovered by TP and TR MRI-TB, we combined the relative sensitivity (RR) with 95% confidence intervals (CI). The RR between the TP and TR routes was established.

Results

Our study included 8826 patients in total and revealed that TP MRI-TB detected more PCa (RR 1.25 [95% CI 1.12, 1.39], p < 0.0001). In patients who underwent TP MRI-TB and TR MRI-TB at the same time or separately, TP MRI-TB had a greater detection rate of csPCa in per-patient analysis (one cohort (RR 1.33 [95% CI 1.09, 1.63], p = 0.005); two cohorts (RR 1.37 [95% CI 1.16, 1.61], p  = 0.0002)). However, the detection rate of csPCa between the TP route and the TR route was comparable in per-lesion analysis (RR 0.91 [95% CI 0.76, 1.08], p  = 0.28). Additionally, in the prostate’s anterior region, we found that TP MRI-TB detected more csPCa (per-lesion (RR 1.52 [95% CI 1.04, 2.23], p  = 0.03); per-patient (RR 2.55 [95% CI 1.56, 4.16], p  = 0.0002)).

Conclusion

According to this comprehensive study, TP MRI-TB is more effective than TR MRI-TB at detecting PCa and csPCa. Significant results persisted for detecting csPCa located in the anterior zone. The results need to be taken carefully notwithstanding the heterogeneity among the included studies.

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Fig. 1
Fig. 2
Fig. 3
Fig. 4: Forest plots of comparison of detecting rates of csPCa between TP route and TR route in two cohorts studies.
Fig. 5: Forest plots of comparison of detecting rates of csPCa in anterior zone between TP route and TR route in per-patient analysis and per-lesion analysis.
Fig. 6
Fig. 7

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Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

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Acknowledgements

The authors thank Dr. Chi Chen, Changzhong Chen, and Xing-Lin Chen for providing statistical methodology consultation.

Funding

This work was supported by the National Natural Science Foundation of China (Grant number: 81500522) and Science & Technology Department of Sichuan Province (Grant number: 2020YFS0090, 2020YFS0046) and Cadre Health Research Project of Sichuan Province (Grant number: ZH2023-102)

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Author notes

  1. These authors contributed equally: Qiyou Wu, Xiang Tu, Chichen Zhang.

Authors and Affiliations

  1. Department of Urology, West China Hospital, Sichuan University, Chengdu, China

    Qiyou Wu, Xiang Tu, Chichen Zhang, Jianjun Ye, Tianhai Lin, Zhenhua Liu, Lu Yang, Shi Qiu, Yige Bao & Qiang Wei

  2. Department of Molecular Oncology, Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500, Switzerland

    Shi Qiu

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Contributions

Conceptualization: XT, QW, YGB. Data curation: QYW, CCZ. Formal analysis: QYW, CCZ, XT. Data collection: QYW, CCZ, XT, JJY, THL, ZHL, LY, SQ. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Yige Bao or Qiang Wei.

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Wu, Q., Tu, X., Zhang, C. et al. Transperineal magnetic resonance imaging targeted biopsy versus transrectal route in the detection of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00729-4

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