Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative MRI: A Systematic Review and Meta-Analysis

Review Article | Journal of Urology




auajournals.org

Predictive Factors of Missed Clinically
Significant Prostate Cancers in Men with Negative MRI: A Systematic
Review and Meta-Analysis

J Olivier
2 minutes




Abstract


Objective:

To systematically review the literature on predictive factors for csPCa diagnosis
after nMRI in PCa-naïve patients.




Evidence Acquisition:

The Medline and Scopus databases were searched up to March 2019. The review protocol
was published in the PROSPERO database (CRD42019125549). The clinical factors and
markers studied were age, PSA, PSA isoforms, PSA density (PSAD), PCA3, prostate volume,
family history, ethnicity, and risk calculators. The primary objective was to determine
their predictive ability for csPCa diagnosis. Secondary objectives included meta-analysis
of the NPV of nMRI when combined with these predictive factors.




Evidence Synthesis:

A total of 16 studies were eligible for inclusion. Few studies reported NPV of MRI
combined with a marker. PSAD was the best studied and the strongest predictor of csPCa
in men with nMRI. Eight studies (1015 patients) were eligible for meta-analysis of
the added value of PSAD< 0.15ng/ml/ml to MRI in reducing the risk of missing csPCa.
When combined with PSAD, overall MRI NPV increased from 84.4% to 90.4% in cancer naïve
patients. The increase was from 82.7% to 88.7% in biopsy naïve and from 88.2% to 94.1%
in previous negative biopsy sub-groups.




Conclusion:

The use of PSAD<0.15ng/ml/ml in the presence of a nMRI was the most useful factor
to identify men without csPCa who could avoid biopsy.



© 2020 by American Urological Association Education and Research, Inc.

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