The role of real-time elastography-targeted biopsy in the detection and diagnosis of prostate cancer: A systematic review and meta-analysis

BACKGROUND: The role of real-time elastography (RTE)-targeted biopsy in the detection and diagnosis of prostate cancer (PCa) remains controversial. METHODS: We searched Medline, Embase, and Cochrane Library from inception to July 31, 2017 and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the quality of the identified studies. We applied the relative sensitivity value to assess the diagnostic accuracy of RTE-targeted biopsy using the 10-core systematic biopsy as the reference standard. RESULTS: Seven studies comprising 5 cohorts and 2 randomized controlled trials (RCTs) were included. Of the 5 cohorts that encompassed 698 participants, we found that RTE-targeted biopsy did not outperform systematic biopsy in either overall PCa detection (69.5% vs 80.5%, relative sensitivity 0.92, 95% CI 0.80–1.06) or for the initial biopsy (56.8% vs 64.0%, relative sensitivity 0.93, 95% CI 0.79–1.11). For the core-by-core analysis, more positive cores were detected by RTE-targeted biopsy than systematic biopsy (21% vs 11%, relative sensitivity 2.17, 95% CI 1.61–2.95). The 2 RCTs showed a favorable trend toward greater PCa detection when a combination of systematic biopsies and RTE-targeted biopsies was used than when systematic biopsy alone was used (45.5% vs 39.5%, risk ratio (RR) 1.18, 95% CI 0.98–1.43). CONCLUSION: Currently, there is not enough evidence to demonstrate that RTE-targeted biopsy can outperform systematic biopsy, but the combination of systematic and RTE-targeted biopsy may be a promising approach for improving PCa detection.