ImportanceProstate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway.ObjectiveTo systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)–based screening with systematic biopsy strategies.Data SourcesPubMed/MEDLINE, Embase, Cochrane/Central, Scopus, and Web of Science (through May 2023).Study SelectionRandomized clinical trials and prospective cohort studies were eligible if they reported data on the diagnostic utility of prostate MRI in the setting of PCa screening.Data ExtractionNumber of screened individuals, biopsy indications, biopsies performed, clinically significant PCa (csPCa) defined as International Society of Urological Pathology (ISUP) grade 2 or higher, and insignificant (ISUP1) PCas detected were extracted.Main Outcomes and MeasuresThe primary outcome was csPCa detection rate. Secondary outcomes included clinical insignificant PCa detection rate, biopsy indication rates, and the positive predictive value for the detection of csPCa.Data SynthesisThe generalized mixed-effect approach with pooled odds ratios (ORs) and random-effect models was used to compare the MRI-based and PSA-only screening strategies. Separate analyses were performed based on the timing of MRI (primary/sequential after a PSA test) and cutoff (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3 or ≥4) for biopsy indication.ResultsData were synthesized from 80 114 men from 12 studies. Compared with standard PSA-based screening, the MRI pathway (sequential screening, PI-RADS score ≥3 cutoff for biopsy) was associated with higher odds of csPCa when tests results were positive (OR, 4.15; 95% CI, 2.93-5.88; P ≤ .001), decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36; P ≤ .001), and insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49; P = .002) without significant differences in the detection of csPCa (OR, 1.02; 95% CI, 0.75-1.37; P = .86). Implementing a PI-RADS score of 4 or greater threshold for biopsy selection was associated with a further reduction in the odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97; P = .048) and biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; P = .01) without differences in csPCa detection (OR, 0.85; 95% CI, 0.49-1.45; P = .22).Conclusion and relevanceThe results of this systematic review and meta-analysis suggest that integrating MRI in PCa screening pathways is associated with a reduced number of unnecessary biopsies and overdiagnosis of insignificant PCa while maintaining csPCa detection as compared with PSA-only screening.

中文翻译：

---

磁共振成像在前列腺癌筛查中的应用


重要性前列腺磁共振成像 (MRI) 越来越多地融入前列腺癌 (PCa) 早期检测途径。目的系统评估有关 MRI 与靶向活检相结合的筛查途径的现有证据，并评估其与前列腺特异性抗原 (PSA) 相比的诊断价值 –基于系统活检策略的筛查。数据来源PubMed/MEDLINE、Embase、Cochrane/Central、Scopus 和 Web of Science（截至 2023 年 5 月）。研究选择如果随机临床试验和前瞻性队列研究报告了有关前列腺诊断效用的数据，则这些研究是合格的PCa 筛查中的 MRI。数据提取筛选的个体数量、活检指征、进行的活检、定义为国际泌尿病理学会 (ISUP) 2 级或更高级别的临床显着 PCa (csPCa) 和检测到的不显着 (ISUP1) PCa主要结果和措施主要结果是csPCa 检出率。次要结局包括临床意义不显着的 PCa 检出率、活检指征率以及 csPCa 检出的阳性预测值。数据综合采用合并比值比 (OR) 和随机效应模型的广义混合效应方法来比较 MRI-基于 PSA 的筛查策略。根据 MRI 的时间（PSA 测试后的初次/序贯）和活检指示的截止时间（前列腺成像报告和数据系统 [PI-RADS] 评分 ≥3 或 ≥4）进行单独分析。结果数据由 80 114 名患者合成来自12项研究的男性。 与基于 PSA 的标准筛查相比，当测试结果呈阳性时，MRI 途径（序贯筛查、PI-RADS 评分≥3 活检截止值）与 csPCa 的几率较高相关（OR，4.15；95% CI，2.93-5.88；磷≤ .001），活检的几率降低（OR，0.28；95% CI，0.22-0.36；磷≤ .001），并且检测到微不足道的癌症（OR，0.34；95% CI，0.23-0.49；磷= .002）csPCa 检测没有显着差异（OR，1.02；95% CI，0.75-1.37；磷= .86）。将 PI-RADS 评分设置为 4 或更高的活检选择阈值与进一步降低检测到不显着 PCa 的几率相关（OR，0.23；95% CI，0.05-0.97；磷= .048）并进行活检（OR，0.19；95% CI，0.09-0.38；磷= .01) csPCa 检测没有差异（OR，0.85；95% CI，0.49-1.45；磷= .22). 结论和相关性本系统评价和荟萃分析的结果表明，与仅 PSA 筛查相比，将 MRI 整合到 PCa 筛查途径中与减少不必要的活检数量和微不足道的 PCa 的过度诊断有关，同时保持 csPCa 检测。 。