Optimizing the strategies to perform prostate biopsy in MRI-positive patients: A systematic review and network meta-analysis.

340 Background: Prostate cancer (PCa) is the most commonly diagnosed cancer in men, and early detection is crucial for better patient outcomes. This study aimed to thoroughly compare existing biopsy schemes for patients with suspicious lesions. Methods: This study conducted a systematic review and network meta-analysis following PRISMA guidelines, evaluating 13 biopsy schemes for detecting PCa in MRI-positive patients. Data from PubMed, Embase, and Cochrane databases were examined to assess the efficacy of biopsy schemes in detecting clinically significant (csPCa) and clinically insignificant (ciPCa) prostate cancer. Results: The analysis included 188 studies involving 64637 individuals. When compared with the combination of systematic biopsy (SB) and targeted biopsy (TB) (SB+TB), ipsilateral SB with TB (ips-SB+TB) and saturation TB (≥ 6 cores TB with or without perilesional cores) had comparable detection rate of csPCa (ips-SB+TB: RR 0.94, 95%CrI 0.87, 1.0; saturation TB: RR 0.94, 95%CrI 0.89, 1.0). While, saturation SB+TB and SB saturation (> 20 cores SB) detected slightly more csPCa than SB+TB (saturation SB+TB: RR 1.04, 95%CrI 0.97, 1.11; saturation TB: RR 1.09, 95%CrI 0.93, 1.29). And TB and SB alone detected significantly less csPCa than SB+TB (TB: RR 0.86, 95%CrI 0.84, 0.88; SB: RR 0.74, 95%CrI 0.72, 0.76). Saturation SB also did not show significant superiority in detecting csPCa. Additionally, saturation TB and ips-SB+TB also decrease the detection of ciPCa. (ips-SB+TB: RR 0.87, 95%CrI 0.73, 1.04; saturation TB: RR 0.81, 95%CrI 0.70, 0.94). The SUCRA results are detailed (Table). Conclusions: The network meta-analysis underscores that saturation SB+TB and SB+saturation TB can detect the most PCa. While, ips-SB+TB and saturation TB are effective biopsy strategies for MRI-positive PCa patients, offering a more targeted approach, improving diagnostic accuracy. Ranking probability of different biopsy schemes. PCa csPCa ciPCa Biopsy schemes Cumulative Probability Biopsy schemes Cumulative Probability Biopsy schemes Cumulative Probability 1 SB+saturation TB 0.936 SB+saturation TB 0.954 SB+saturation TB 0.958 2 saturation SB+TB 0.920 saturation SB+TB 0.922 saturation SB+TB 0.910 3 SB+TB 0.840 SB+TB 0.842 saturation SB 0.768 4 ips-SB+TB 0.621 ips-SB+TB 0.682 SB+TB 0.739 5 saturation SB 0.590 saturation TB 0.675 ips-SB+TB 0.520 6 saturation TB 0.536 non-targeted SB+TB 0.549 con-SB+TB 0.427 7 non-targeted SB+TB 0.524 saturation SB 0.489 non-targeted SB+TB 0.424 8 con-SB+TB 0.470 con-SB+TB 0.487 SB 0.392 9 TB 0.240 TB 0.401 saturation TB 0.381 10 SB 0.229 SB 0.250 ips-SB 0.306 11 ips-SB 0.096 ips-SB 0.143 con-SB 0.089 12 con-SB 0.000 adjacent sextant SB 0.108 TB 0.085 13 con-SB 0