Diagnostic Performance of Multiparametric MRI for the Detection of suspected Prostate Cancer in Biopsy-Naive Patients: A Systematic Review and Meta-analysis

Rationale and Objectives

This meta-analysis aimed to assess the diagnostic accuracy of multiparametric MRI (mpMRI) in detecting suspected prostate cancer (PCa) in biopsy-naive men.

Materials and Methods

PubMed, Scopus, and the Cochrane Library databases were systematically searched for studies published from January 2013 to April 2024. Sixteen studies comprising 4973 patients met the inclusion criteria. Data were extracted to construct 2×2 contingency tables for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A random-effects model was used for pooled estimation, and subgroup analyses were conducted. Summary receiver operating characteristic (SROC) curves were generated to summarize overall diagnostic performance.

Results

The overall detection rate of PCa across studies was 57.3%. For detecting any PCa, mpMRI showed pooled sensitivity of 82% (95% CI, 80–83%) and specificity of 62% (95% CI, 60–64%), with positive likelihood ratio (LR) of 1.97 (95% CI, 1.71–2.26), negative LR of 0.28 (95% CI, 0.24–0.34), and diagnostic odds ratio (DOR) of 7.34 (95% CI, 5.60–9.63), and an area under the SROC curve of 0.81. For clinically significant PCa (csPCa), mpMRI had pooled sensitivity of 88% (95% CI, 87–90%) and specificity of 64% (95% CI, 63–66%), with positive LR of 2.49 (95% CI, 2.03–3.05), negative LR of 0.20 (95% CI, 0.16–0.25), DOR of 13.83 (95% CI, 9.14–20.9), and area under the curve of 0.90.

Conclusion

This meta-analysis suggests that mpMRI is effective in detecting PCa in biopsy-naive patients, particularly for csPCa. It can help reduce unnecessary biopsies and lower the risk of missing clinically significant cases, thereby guiding informed biopsy decisions.