From: Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore
Diagnostic test | Uptake | True localized cancer status | Diagnostic test findings | Sources |
---|---|---|---|---|
mpMRI | 100% | No cancer | • No suspicion of cancer or suspicion of low-risk cancer: 50% • Suspicion of low-risk cancer: 17% • Suspicion of intermediate or high-risk cancer: 50% | NICE, 2019; Brown et al., 2018 |
Low-risk cancer | • No suspicion of cancer or suspicion of low-risk cancer: 44% • Suspicion of low-risk cancer: 16% • Suspicion of intermediate or high-risk cancer: 56% | |||
Intermediate or high-risk cancer | • No suspicion of cancer or suspicion of low-risk cancer: 13% • Suspicion of low-risk cancer: 5% • Suspicion of intermediate or high-risk cancer: 87% | |||
First biopsy: systematic biopsy without prior mpMRI | 100% | Low-risk cancer | • P (Low|Low): 35% | Brown et al., 2018; Drost et al., 2019 |
Intermediate cancer | • P (Low|Intermediate): 17% • P (Intermediate|Intermediate): 59% | |||
High-risk cancer | • P (High|High): 100% | |||
First biopsy: MRI targeted biopsy after a suspicious mpMRI result | 100% | Low-risk cancer | • P (Low|Low): 35% | |
Intermediate cancer | • P (Low|Intermediate): 8% • P (Intermediate|Intermediate): 79% | |||
High-risk cancer | • P (High|High): 100% | |||
Second biopsy: systematic biopsy following a negative systematic biopsy | 71% | Low-risk cancer | • P (Low|Low): 45% | |
Intermediate cancer | • P (Low|Intermediate): 10% • P (Intermediate|Intermediate): 35% | |||
High-risk cancer | • P (High|High): - | |||
Second biopsy MRI targeted biopsy following a suspicious mpMRI result and no cancer on prior systematic biopsy | 71% | Low-risk cancer | • P (Low|Low): 45% | |
Intermediate cancer | • P (Low|Intermediate): 6% • P (Intermediate|Intermediate): 88% | |||
High-risk cancer | • P (High|High): - | |||
Third biopsy: saturation biopsy | 71% | Low-risk cancer | • Sensitivity: 95% • Specificity: 100% | Expert opinion |
Intermediate cancer | • Sensitivity: 95% • Specificity: 100% | |||
High-risk cancer | • Sensitivity: 95% • Specificity: 100% |