Prostate Cancer Detection: Accuracy of Multiparametric MRI For Detection

Dr. Maarten de Rooij MD, PhD Candidate Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland 6525 GA, The Interview with:
Dr. Maarten de Rooij MD, PhD Candidate
Department of Radiology
Radboud University Nijmegen Medical Centre
Nijmegen, Gelderland 6525 GA, The Netherlands What are the main findings of the study?

Dr. de Rooij : Prostate cancer is the most common cancer in men and the second leading cause of cancer related death. The current diagnosis is based on ‘random or blind’ systematic transrectal ultrasound guided prostate biopsies in men with an elevated PSA. This can lead to over-diagnosis and over-treatment of prostate cancer, but can also miss important tumors. The role of multiparametric MRI (mpMRI) to improve the diagnosis of prostate cancer is evolving. In this meta-analysis we determined the diagnostic accuracy of mpMRI for the detection of prostate cancer. Our analysis included 7 studies using mpMRI which showed high overall specificity (0.88; 95% CI 0.82-0.92), with variable but high negative predictive values (0.65 – 0.95) and sensitivities (0.74; 95% CI 0.66-0.81). any of the findings unexpected?

Dr. de Rooij: One of the things we encountered was the difference in quality of reporting between the included studies. The overall quality was fair, but the quality assessment showed that there is still room for improvement. Two factors that contribute to the loss of quality are methodological weaknesses and failure to report sufficient information to reproduce a study. When performing a diagnostic meta-analysis it is important to systematically assess the quality of the included studies with the QUADAS-2 tool. An overview of the quality can give readers insight into the value of the outcomes of the meta-analysis. should clinicians and patients take away from your report?

Dr. de Rooij:Our study shows the potential of mpMRI to improve prostate cancer detection. Recent prospective studies support our findings and show the benefits of an MRI based diagnostic pathway in which MRI is performed before MR-targeted prostate biopsy. As with mp-MRI predominantly significant Prostate Cancer is seen and indolent cancer is not diagnosed, this technique has the potential to solve the problems of the current TRUSGB driven diagnostic pathway. recommendations do you have for future research as a result of this study?

Dr. de Rooij: Researchers should be aware of the available guidelines for reporting (STARD guidelines) and the criteria that are used to assess the study quality (QUADAS-2 tool). Furthermore, it is important to involve someone with sufficient methodological knowledge to prevent flaws in the study design. The STARD guideline and QUADAS-2 tool provide recommendations and a checklist which can help researchers improve their future diagnostic research.


Accuracy of Multiparametric MRI for Prostate Cancer Detection: A Meta-Analysis

Maarten de Rooij1, , Esther H. J. Hamoen1, 3, Jurgen J. Fütterer1, Jelle O. Barentsz1 and Maroeska M. Rovers,

American Journal of Roentgenology February 2014, Volume 202, Number 2