Limited evidence for the use of imaging to detect prostate cancer: A systematic review

• In men with clinical suspicion of prostate cancer, ultrasound guided systematic biopsies is the golden standard for diagnosis.
• Diagnostic imaging techniques, especially magnetic resonance imaging, is being used in trials to aid detection of prostate cancer.
• To date, there is insufficient scientific evidence for the use of imaging techniques to detect prostate cancer.

ObjectiveTo assess the diagnostic accuracy of imaging technologies for detecting prostate cancer in patients with elevated PSA-values or suspected findings on clinical examination.MethodsThe databases Medline, EMBASE, Cochrane, CRD HTA/DARE/NHS EED and EconLit were searched until June 2013. Pre-determined inclusion criteria were used to select full text articles. Risk of bias in individual studies was rated according to QUADAS or AMSTAR. Abstracts and full text articles were assessed independently by two reviewers. The performance of diagnostic imaging was compared with systematic biopsies (reference standard) and sensitivity and specificity were calculated.ResultsThe literature search yielded 5141 abstracts, which were reviewed by two independent reviewers. Of these 4852 were excluded since they did not meet the inclusion criteria. 288 articles were reviewed in full text for quality assessment. Six studies, three using MRI and three using transrectal ultrasound were included. All were rated as high risk of bias. Relevant studies on PET/CT were not identified.ConclusionDespite clinical use, there is insufficient evidence regarding the accuracy of imaging technologies for detecting cancer in patients with suspected prostate cancer using TRUS guided systematic biopsies as reference standard.