This NIHR HTA-funded evidence synthesis aimed at assessing the diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy (MRS), enhanced dynamic contrast-enhanced MRI (DCE-MRI), and diffusion weighted MRI (DW-MRI) in localising prostate abnormalities for biopsy in men with prior negative biopsy for whom harbouring malignancy was still suspected. In the UK prostate cancer is the most common cancer in men and the second most common cause of cancer death in men after lung cancer.

This project included a systematic review of diagnostic attest accuracy to compared the accuracy of MRS, DCE-MRI and DW-MRI with T2-weighted magnetic resonance imaging (T2-MRI) and transrectal ultrasound-guided biopsy (TRUS) against histopathology (biopsied tissues) as reference standard; and an economic model to assess the cost-effectiveness of using alternative MRI/MRS sequences for directing TRUS-guided biopsies compared with an extended-cores TRUS-guided approach.

Fifty-one studies involving over 10,000 men were included in this assessment. MRS had higher sensitivity and specificity than T2-MRI. Few studies reported DCE-MRI or DW-MRI. The cost-effectiveness of MRS compared with T2-MRI and TRUS was sensitive to several key parameters. If MRS and DW-MRI can be shown to have high sensitivity for detecting moderate/high-risk cancer, while avoiding the need for men with no cancer/low-risk disease undergoing biopsy, they could represent a cost-effective approach to diagnosis. However, owing to the relative paucity of reliable data, further studies are required. In particular, comparisons of the individual and combined components of a multiparametric magnetic resonance (MR) approach (MRS, DCE-MRI and DW-MRI) with both a MR-biopsy session and an extended TRUS-guided biopsy scheme would be useful.


Moira Cruickshank;




Mowatt, G, Scotland, G, Boachie, C, Cruickshank, M, Ford, J, Fraser, C, Kurban, L, Lam, TB, Padhani, AR, Royle, J, Scheenen, TW, Tassie, E  The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess 2013;17(20)