Magnetic resonance imaging/ultrasound fusion-guided targeted biopsy and ultrasound-guided systematic biopsy for prior negative prostate biopsy: A meta-analysis

ABSTRACT Introduction: The comparative efficacy of magnetic resonance imaging (MRI)/ultrasound fusion-guided targeted biopsy (MRI-TBx) versus systematic ultrasound-guided biopsy (TRUS-Bx) for the detection of prostate cancer (PCa) in men with prior negative biopsies remains clinically undefined. Methods: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent meta-analysis searched Web of Science, PubMed, and EMBASE (through December 2024) for studies comparing MRI-TBx and TRUS-Bx in repeat biopsy cohorts. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a fixed-effects model. Results: Pooled analysis of seven studies (including two randomized trials) involving 459 patients with prior negative biopsies showed that the overall cancer detection rates were comparable: 73% (172/235) with MRI-TBx versus 77% (181/235) with TRUS-Bx (RR = 0.97, 95% CI = 0.82–1.14, P = 0.232). However, MRI-TBx detected a higher proportion of clinically significant PCa (Gleason score s7) (84.4% vs. 65.1%) and reduced the diagnosis of indolent cancer (Gleason score