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Multiparametric Magnetic Resonance Imaging in the Diagnosis of Clinically Significant Prostate Cancer

ID: 27-2 Aug 2015
Type of Content: Guidelines & Advice, Clinical
Document Status: Current
Authors:
M.A. Haider, X. Yao, D.A. Loblaw, A. Finelli , MRI in Prostate Cancer Guideline Development Group

Guideline Objective

  1. To make recommendations with respect to the use of multiparametric magnetic resonance imaging (MPMRI) in the diagnosis of clinically significant prostate cancer in patients with an elevated risk of clinically significant prostate cancer (according to prostate-specific antigen [PSA] level and/or nomograms) who are biopsy-naïve.
  2. To make recommendations with respect to the use of MPMRI in the diagnosis of clinically significant prostate cancer in patients with a growing risk of having clinically significant prostate cancer (e.g., continued rise in PSA) who had a negative transrectal ultrasound-guided (TRUS-guided) systematic biopsy.

Patient Population

Patients with an elevated risk of clinically significant prostate cancer (according to PSA level and/or nomograms) who are biopsy-naïve or have a prior negative TRUS-guided systematic biopsy.

Intended Guideline Users

Radiologists, family physicians, oncologists, urological surgeons, and other clinicians who provide care for patients defined by the target patient population.

Research Question(s)

  1. For biopsy-naïve patients with an elevated risk of clinically significant prostate cancer (according to prostate-specific antigen [PSA] levels and/or nomograms):
  1. Does MPMRI or MPMRI followed by targeted biopsy add value in detecting clinically significant prostate cancer (diagnostic accuracy outcomes including sensitivity, specificity, predictive value, and upgraded/downgraded results from MPMRI followed by targeted biopsy and TRUS-guided systematic biopsy), positively change patient management, or improve patient outcomes (including side effects and survival outcomes)?
  2. Is MPMRI followed by targeted biopsy better than TRUS-guided systematic biopsy (at least eight cores) for detection rate of clinically significant prostate cancer, and the other above patient outcomes?
  1. For patients who had a previous negative TRUS-guided systematic biopsy (at least eight cores) with a growing risk of having clinically significant prostate cancer (e.g., continued rise in PSA):
  1. Does MPMRI or MPMRI followed by targeted biopsy add value in detecting clinically significant prostate cancer (diagnostic accuracy outcomes including sensitivity, specificity, predictive value, and upgraded/downgraded results from MPMRI followed by targeted biopsy and TRUS-guided systematic biopsy), positively change patient management, or improve patient outcomes (including side effects and survival outcomes)?
  2. Is MPMRI followed by targeted biopsy better than repeated TRUS-guided systematic biopsy (at least eight cores) for detection rate of clinically significant prostate cancer, and the other above patient outcomes?
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