Rahman Ilham Akbar, Nusaly Ilham Fauzan, Syahrir Syakri, Nusaly Harry, Kasim Firdaus
Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Indian J Urol. 2021 Jan-Mar;37(1):20-31. doi: 10.4103/iju.IJU_187_20. Epub 2021 Jan 1.
Overdiagnosis and overtreatment are well known problems in prostate cancer (PCa). The transrectal ultrasound (TRUS) Guided biopsy (GB) as a current gold standard investigation has a low positive detection rate resulting in unnecessary biopsies. The choice of optimal biopsy strategy needs to be defined. Therefore, we undertook a Bayesian network meta analysis (NMA) and Bayesian prediction in the hierarchical summary receiver operating characteristic (HSROC) model to present a method for optimizing biopsy strategy in PCa. Twenty eight relevant studies were retrieved through online databases of EMBASE, MEDLINE, and CENTRAL up to February 2020. Markov chain Monte Carlo simulation and Surface Under the Cumulative RAnking curve were used to calculate the rank probability using odds ratio with 95% credible interval. HSROC model was used to formulate the predicted true sensitivity and specificity of each biopsy strategy. Six different PCa biopsy strategies including transrectal ultrasound GB (TRUS GB), fusion GB (FUS GB), fusion + transrectal ultrasound GB (FUS + TRUS GB), magnetic resonance imaging GB (MRI GB), transperineal ultrasound GB (TPUS GB), and contrast enhanced ultrasound GB were analyzed in this study with a total of 7584 patients. These strategies were analyzed on five outcomes including detection rate of overall PCa, clinically significant PCa, insignificant PCa, complication rate, and HSROC. The rank probability showed that the overall PCa detection rate was higher in FUS + TRUS GB, MRI GB, and FUS GB. In terms of clinically significant PCa detection, FUS + TRUS GB and FUS GB had a relatively higher clinically significant PCa detection rate, whereas TRUS GB had a relatively lower rate for clinically significant PCa detection rate. MRI GB (91% and 81%) and FUS GB (82% and 83%) had the highest predicted true sensitivity and specificity, respectively, whereas TRUS GB (62% and 83%) had a lower predicted true sensitivity and specificity. MRI GB, FUS GB, and FUS + TRUS GB were associated with lower complication rate, whereas TPUS GB and TRUS GB were more associated with higher complication rate. This NMA and HSROC model highlight the important finding that FUS + TRUS GB, FUS GB, and MRI GB were superior compared with other strategies to avoid the overdiagnosis and overtreatment of PCa. FUS GB, MRI GB, and FUS + TRUS GB had lower complication rates. These results may assist in shared decision making between patients, carers, and their surgeons.
过度诊断和过度治疗是前列腺癌（PCa）中众所周知的问题。经直肠超声（TRUS）引导活检（GB）作为当前的金标准检查，阳性检出率较低，导致不必要的活检。需要确定最佳活检策略的选择。因此，我们进行了贝叶斯网络荟萃分析（NMA）和分层汇总接受者操作特征（HSROC）模型中的贝叶斯预测，以提出一种优化PCa活检策略的方法。截至2020年2月，通过EMBASE、MEDLINE和CENTRAL在线数据库检索到28项相关研究。使用马尔可夫链蒙特卡罗模拟和累积排名曲线下面积，以95%可信区间的优势比计算排名概率。HSROC模型用于制定每种活检策略的预测真敏感性和特异性。本研究分析了六种不同的PCa活检策略，包括经直肠超声GB（TRUS GB）、融合GB（FUS GB）、融合+经直肠超声GB（FUS+TRUS GB）、磁共振成像GB（MRI GB）、经会阴超声GB（TPUS GB）和对比增强超声GB，共7584例患者。对这些策略在五个结局上进行了分析，包括总体PCa检出率、临床显著性PCa、非显著性PCa、并发症发生率和HSROC。排名概率显示，FUS+TRUS GB、MRI GB和FUS GB的总体PCa检出率较高。在临床显著性PCa检测方面，FUS+TRUS GB和FUS GB的临床显著性PCa检出率相对较高，而TRUS GB的临床显著性PCa检出率相对较低。MRI GB（91%和81%）和FUS GB（82%和83%）分别具有最高的预测真敏感性和特异性，而TRUS GB（62%和83%）的预测真敏感性和特异性较低。MRI GB、FUS GB和FUS+TRUS GB的并发症发生率较低，而TPUS GB和TRUS GB的并发症发生率较高。这项NMA和HSROC模型突出了一个重要发现，即FUS+TRUS GB、FUS GB和MRI GB在避免PCa的过度诊断和过度治疗方面优于其他策略。FUS GB、MRI GB和FUS+TRUS GB的并发症发生率较低。这些结果可能有助于患者、护理人员及其外科医生之间的共同决策。
