title: Limited evidence for the use of imaging to detect prostate cancer: a systematic review.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of imaging technologies for detecting prostate cancer in patients with elevated PSA-values or suspected findings on clinical examination.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Despite 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.
authors: Department of Diagnostic Radiology, Karolinska University Hospital, Solna, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: lennart.k.blomqvist@ki.se.
authors: L
authors: L
authors: Blomqvist
authors: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital, Solna, Sweden.
authors: S
authors: S
authors: Carlsson
authors: Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: P
authors: P
authors: Gjertsson
authors: The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
authors: E
authors: E
authors: Heintz
authors: The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
authors: M
authors: M
authors: Hultcrantz
authors: The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
authors: I
authors: I
authors: Mejare
authors: School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Urology, Örebro University Hospital, Örebro, Sweden.
authors: O
authors: O
authors: Andrén
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: Biopsy; Diagnosis; Imaging; Meta-analysis; Prostate cancer; Systematic review