A comparison of prostate cancer detection rates between TRUS-GB and MRI-GB: a systematic review and meta-analysis

Abstract Background Prostate cancer (PCa) is one of the most common cancers in men and a major cause of cancer-related death. Accurate diagnosis is essential to identify clinically significant cases while avoiding overdiagnosis. Traditionally, prostate biopsies are performed as systematic sampling using transrectal ultrasound guidance (systematic TRUS-GB), whereas lesion-targeted multiparametric magnetic resonance imaging–guided biopsy (lesion-targeted mpMRI-GB) has emerged as a promising alternative. While lesion-targeted mpMRI-GB may improve cancer detection, its clinical advantage over systematic TRUS-GB remains debated. This meta-analysis compares the detection rates of PCa between lesion-targeted mpMRI-GB and systematic TRUS-GB in biopsy-naive patients. Main body We systematically searched PubMed, Cochrane Central, Scielo, and LILACS for studies comparing lesion-targeted mpMRI-GB to systematic TRUS-GB in biopsy-naive patients suspected of having PCa. Outcomes included the detection rate of overall PCa, clinically significant PCa, clinically insignificant PCa, and missed diagnoses. We included 9,165 patients from 14 studies, of which three were randomized controlled trials (RCTs). lesion-targeted mpMRI-GB was used to diagnose overall PCa in 4,349 (47,45%) patients. The cancer detection rate of overall PCa (RR 1.26; 95% CI 1.02–1.55; p < 0.00001; i² = 95%) and clinically significant PCa (RR 1.46; 95% CI 1.11–1.93; p = 0.007; i² = 93%) were significantly higher in patients diagnosed with lesion-targeted mpMRI-GB. The detection rate of clinically insignificant cancer (RR 0.85; CI 0.64–1.13; p = 0.25; I² = 77%) was not statistically significant. However, missed diagnoses were lower in the systematic TRUS-GB group, showing a potential difference. Subgroup analysis was evaluated. Conclusions Using lesion-targeted mpMRI-GB as a first-line approach increases the likelihood of detecting clinically significant prostate cancer. However, lesion-targeted mpMRI-GB has not demonstrated clear superiority over systematic TRUS-GB in reducing missed diagnoses, suggesting that the choice of technique should be individualized or that a combined biopsy strategy may be considered.