Faculty Bibliography

PURPOSE/OBJECTIVE:We update the prior AUA SOP for MRI of the prostate and summarize the available data about the technique and clinical use of MRI in the diagnosis and management of prostate cancer. This updated SOP provides practical recommendations for MRI use in the screening, diagnosis, staging, treatment, and surveillance of prostate cancer. MATERIALS AND METHODS/METHODS:A panel of clinicians from the AUA and SAR with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and technique MRI for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus. RESULTS:Prostate MRI should be performed according to technical specifications, technique standards, and interpreted according to standard reporting. Data support the use of MRI in men with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. Sufficient data now also exist to support the recommendation of MRI prior to biopsy for all men, without previous history of biopsy, under consideration for prostate biopsy. There is currently insufficient evidence to recommend MRI for screening, staging or surveillance of prostate cancer. CONCLUSIONS:Utility of prostate MRI in the risk stratification, diagnosis, and treatment pathway of men with prostate cancer is expanding. When a quality prostate MRI is obtained, current evidence now supports its use in men at risk of harboring prostate cancer prior to their first biopsy, as well as in men with a rising PSA following an initial negative standard prostate biopsy procedure.

PURPOSE/OBJECTIVE:Multiparametric magnetic resonance imaging (mpMRI) with informed targeted biopsies (TGBX) has changed the paradigm of prostate cancer (PCa) diagnosis. Randomized studies have demonstrated a diagnostic benefit of Clinically significant (CS) for TGBX compared to standard systematic biopsies (SBX). We aimed to evaluate whether mpMRI-informed TGBX has superior diagnosis rates of any-, CS-, high-grade (HG)-, and clinically insignificant (CI)-PCa compared to SBX in biopsy-naive men. METHODS:Data was searched in Medline, Embase, Web of Science, and Evidence-based medicine reviews-Cochrane Database of systematic reviews from database inception until 2019. Studies were selected by two authors independently, with disagreements resolved by consensus with a third author. Overall 1951 unique references were identified, and 100 manuscripts underwent full-text review. Data were pooled using random-effects models. The meta-analysis is reported according to the PRISMA statement. The study protocol is registered with PROSPERO (CRD42019128468). RESULTS:Overall 29 studies (13,845 patients) were analyzed. Compared to SBX, use of mpMRI-informed TGBX was associated with a 15% higher rate of any PCa diagnosis (95% CI 10-20%, p<0.00001). This relationship was not affected by the study methodology (p=0.11). Diagnosis of CS and HG PCa were more common in the mpMRI-informed TGBX group (risk difference of 11%, 95% CI 0-20%, p=0.05, and 2%, 95% CI 1-4%; p=0.005, respectively) while there was no difference in diagnosis of CI PCa (risk difference of 0, 95% CI -3 to 3%, p=0.96). Notably, the exclusion of SBX in the mpMRI-informed TGBX arm significantly modified the association between a mpMRI strategy and lower rates of CI PCa diagnosis (p=0.01) without affecting the diagnosis rates of CS- or HG-PCa. CONCLUSIONS:In comparison to SBX, a mpMRI-informed TGBX strategy results in a significantly higher diagnosis rate of any-, CS-, and HG-PCa. Excluding SBX from mpMRI-informed TGBX was associated with decreased rates of CI-PCa diagnosis without affecting diagnosis of CS- or HG-PCa.

We convened a multidisciplinary expert panel to make recommendations on current utility and future research needs for post-diagnosis prostate cancer biomarkers. The San Francisco Consensus Statement reflects on the rapid recent progress achieved, and the substantial work still ahead.