Transrectal ultrasound guided systematic biopsy is considered as a gold standard procedure for primary diagnosis of prostate cancer. However, systematic biopsy has been fraught with poor sensitivity and inaccurate risk attribution. This study assessed the current evidence regarding the diagnosis accuracy of multiparametric magnetic resonance imaging targeted biopsy (MRI-TΒ), systematic biopsy (SB) and the combination of TB and SB approaches (CB) in biopsy naïve man.

We comprehensively searched PubMed, Web of Science, Scopus, and the Cochrane Library in 25 October 2017 and performed a systematic review and meta-analysis of all studies comparing the three biopsy scheme in biopsy naïve patients.

Sixteen studies including 2767 cases were identified. MRΙ-TB was significantly inferior than SB in overall prostate cancers diagnosis (RR: 0.94; p = 0.01), but detected more clinical significant prostate cancers (RR: 1.12; p = 0.001). CB was significantly superior than MRI-TB and SB in both overall prostate cancers diagnosis (RR: 1.20; p < 0.00001 and RR: 1.13; p < 0.00001, respectively) and clinical significant cancers diagnosis (RR: 1.11; p = 0.001 and RR: 1.26; p < 0.00001, respectively). In subgroup analysis, TB as well as CB guiding by cognitive fusion imaging did not significantly improved overall cancer diagnosis rate compared to SB (RR: 0.91; p = 0.02 and RR: 1.15; p = 0.16, respectively).

CB is more accurate than either method alone in prostate cancer detection of biopsy naïve men with positive MRI. TB as well as CB guiding by cognitive fusion imaging do not show significant improvement compared to SB alone.

CB is more accurate than either method alone in prostate cancer detection of biopsy naïve men with positive MRI. TB as well as CB guiding by cognitive fusion imaging do not show significant improvement compared to SB alone.