Summary of findings 3. Should MRI be used to diagnose ISUP grade ≥ 2 prostate cancer in men suspected of having clinically significant prostate cancer?
| Question: Should MRI be used to diagnose ISUP grade 2 or higher prostate cancer in men suspected of having clinically significant prostate cancer? | |||||
| Population: men suspected of having clinically significant prostate cancer undergoing their first biopsy (biopsy‐naïve men) or a repeat biopsy (prior‐negative biopsy men) | |||||
| Setting: university hospitals and specialized care centers | |||||
| New test: MRI only | Cut‐off value: MRI score ≥ 3 out of 5 | |||||
| Reference test: template‐guided biopsy, which comprehensively samples all zones of the prostate | Threshold: ISUP grade 2 or higher prostate cancer | |||||
| Pooled sensitivity: 0.91 (95% CI: 0.83 to 0.95) | Pooled specificity: 0.37 (95% CI: 0.29 to 0.46) | |||||
| Test result | Number of results per 1,000 men tested (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | ||
| Prevalence 10% | Prevalence 30% | Prevalence 40% | |||
| True positives | 9 (83 to 95) | 273 (249 to 285) | 364 (332 to 380) | 3091 (12) | ⊕⊕○○ LOWa, b |
| False negatives | 9 (5 to 17) | 27 (15 to 51) | 36 (20 to 68) | ||
| True negatives | 333 (261 to 414) | 259 (203 to 322) | 222 (174 to 276) | 3091 (12) | ⊕⊕○○ LOWa, b |
| False positives | 567 (486 to 639) | 441 (378 to 497) | 378 (324 to 426) | ||
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MRI: magnetic resonance imaging; ISUP: International Society of Urological Pathology; CI: confidence interval aA considerable number of studies had a high or unclear risk of bias, mainly in the participant selection and reference standard domains. bA considerable, clinically relevant heterogeneity was observed across pooled study results. | |||||