title: Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline.
abstract: BACKGROUND
  The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation.
  
  
  RESULTS
  The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11-85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases.
  
  
  CONCLUSIONS
  Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.
authors: McMaster University, Department of Oncology and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada.
authors: Jennifer
authors: J
authors: Salerno
authors: Princess Margaret Hospital, Toronto, ON, Canada.
authors: Antonio
authors: A
authors: Finelli
authors: The Ottawa Hospital, Ottawa, ON, Canada.
authors: Chris
authors: C
authors: Morash
authors: The Ottawa Hospital, Ottawa, ON, Canada.
authors: Scott C
authors: SC
authors: Morgan
authors: Western University, London, ON, Canada.
authors: Nicholas
authors: N
authors: Power
authors: Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada.
authors: Nichola
authors: N
authors: Schieda
authors: Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
authors: Masoom A
authors: MA
authors: Haider