title: Multiparametric MRI followed by targeted prostate biopsy for men with suspected prostate cancer: a clinical decision analysis.
abstract: OBJECTIVE
  To compare the diagnostic outcomes of the current approach of transrectal ultrasound (TRUS)-guided biopsy in men with suspected prostate cancer to an alternative approach using multiparametric MRI (mpMRI), followed by MRI-targeted biopsy if positive.
  
  
  METHODS
  Clinical decision analysis was used to synthesise data from recently emerging evidence in a format that is relevant for clinical decision making.
  
  
  METHODS
  A hypothetical cohort of 1000 men with suspected prostate cancer.
  
  
  METHODS
  mpMRI and, if positive, MRI-targeted biopsy compared with TRUS-guided biopsy in all men.
  
  
  METHODS
  We report the number of men expected to undergo a biopsy as well as the numbers of correctly identified patients with or without prostate cancer. A probabilistic sensitivity analysis was carried out using Monte Carlo simulation to explore the impact of statistical uncertainty in the diagnostic parameters.
  
  
  RESULTS
  In 1000 men, mpMRI followed by MRI-targeted biopsy 'clinically dominates' TRUS-guided biopsy as it results in fewer expected biopsies (600 vs 1000), more men being correctly identified as having clinically significant cancer (320 vs 250), and fewer men being falsely identified (20 vs 50). The mpMRI-based strategy dominated TRUS-guided biopsy in 86% of the simulations in the probabilistic sensitivity analysis.
  
  
  CONCLUSIONS
  Our analysis suggests that mpMRI followed by MRI-targeted biopsy is likely to result in fewer and better biopsies than TRUS-guided biopsy. Future research in prostate cancer should focus on providing precise estimates of key diagnostic parameters.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Willis
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Donaldson
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Alec H
authors.initials: AH
authors.lastname: Miners
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
mesh_terms: D003661:Decision Support Techniques; D003663:Decision Trees; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*
keywords: biopsy; decision trees; diagnosis; prostatic neoplasms