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cancer" /></a></div><div class="bkr_bib"><h1 id="_NBK576979_"><span itemprop="name">Evidence review for diagnosing and identifying clinically significant prostate cancer</span></h1><div class="subtitle">Prostate cancer: diagnosis and management</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 131</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 May</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3375-4</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="chd.s1"><h2 id="_chd_s1_">RQ1. Diagnosing clinically significant prostate cancer</h2><div id="chd.s1.1"><h3>Review question</h3><ul><li class="half_rhythm"><div>Which of the following, alone or in combination, constitutes the most clinically- and cost- effective pathway for diagnosing prostate cancer: Multiparametric MRI; Transrectal ultrasonography (TRUS) biopsy; Transperineal template biopsy?</div></li></ul><div id="chd.s1.1.1"><h4>Introduction</h4><p>This review question aims to capture one of the key themes which prompted early upgrade of the 2014 NICE Guidance CG175: how is the clinical suspicion of prostate cancer best investigated?</p><p>Template biopsy must be the most comprehensive test for identifying prostate cancer, but universal application of this diagnostic approach would have significant cost and morbidity implications, as well as placing an impossible strain on health care services. Template biopsy was therefore used as the standard against which the diagnostic accuracy of mpMRI and/or TRUS biopsy were gauged.</p><p>Evidence from diagnostic test accuracy studies and from randomised controlled trials was used, as set out in PICO <a class="figpopup" href="/books/NBK576979/table/chd.tab1/?report=objectonly" target="object" rid-figpopup="figchdtab1" rid-ob="figobchdtab1">tables 1</a> and <a class="figpopup" href="/books/NBK576979/table/chd.tab2/?report=objectonly" target="object" rid-figpopup="figchdtab2" rid-ob="figobchdtab2">2</a>. For full protocols please see <a href="#chd.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdtab1"><a href="/books/NBK576979/table/chd.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figchdtab1" rid-ob="figobchdtab1"><img class="small-thumb" src="/books/NBK576979/table/chd.tab1/?report=thumb" src-large="/books/NBK576979/table/chd.tab1/?report=previmg" alt="Table 1. PICO table –Diagnostic test accuracy studies." /></a><div class="icnblk_cntnt"><h4 id="chd.tab1"><a href="/books/NBK576979/table/chd.tab1/?report=objectonly" target="object" rid-ob="figobchdtab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO table –Diagnostic test accuracy studies. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdtab2"><a href="/books/NBK576979/table/chd.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figchdtab2" rid-ob="figobchdtab2"><img class="small-thumb" src="/books/NBK576979/table/chd.tab2/?report=thumb" src-large="/books/NBK576979/table/chd.tab2/?report=previmg" alt="Table 2. PICO table –Randomised control studies." /></a><div class="icnblk_cntnt"><h4 id="chd.tab2"><a href="/books/NBK576979/table/chd.tab2/?report=objectonly" target="object" rid-ob="figobchdtab2">Table 2</a></h4><p class="float-caption no_bottom_margin">PICO table –Randomised control studies. </p></div></div></div><div id="chd.s1.1.2"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#chd.appa">appendix A</a>, and the methods section in <a href="#chd.appb">appendix B</a>.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/Code-of-practice-for-declaring-and-managing-conflicts-of-interest.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s 2014 and 2018 conflicts of interest policy</a></p><p>This review was conducted as part of a larger update of the <a href="https://www.nice.org.uk/guidance/cg175" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE Prostate Cancer guideline (CG175)</a>.</p></div><div id="chd.s1.1.3"><h4>Clinical evidence</h4><div id="chd.s1.1.3.1"><h5>Included studies – diagnostic cross sectional studies</h5><p>A systematic literature search for diagnostic cross-sectional studies and systematic reviews of diagnostic cross-sectional studies with a date limit of no earlier than 2007 yielded 5,716 references. These were screened on title and abstract, with 185 full-text papers ordered as potentially relevant diagnostic cross sectional studies primary studies and systematic reviews. Diagnostic cross-sectional studies were excluded if they did not meet the criteria of enrolling patients, they did not include the index tests and the reference standard as specified in the protocol. Studies were further excluded at data extraction if it was impossible to calculate sensitivity and specificity or if the study did not meet any of the other criteria stated in the protocol.</p><p>A second set of searches was conducted at the end of the guideline development process for all updated review questions using the original search strategies to capture papers published whilst the guideline was being developed. These searches, which included articles up to August 2018, returned 917 references for this review question. These were screened on title and abstract and no additional relevant references were found</p><p>Two papers were included after full text screening. Five systematic reviews were identified, however; all were excluded because the included primary studies were already part of this review (see evidence tables for details – <a href="#chd.appe">appendix E</a>).</p></div><div id="chd.s1.1.3.2"><h5>Included studies – Randomised control studies</h5><p>A systematic literature search for randomised controlled trials (RCTs) and systematic reviews of RCTs with a date limit of no earlier than 2007 yielded 2,488 references. These were screened on title and abstract, with 52 full-text papers ordered as potentially relevant RCTs or systematic reviews of RCTs. Studies were excluded if they did not meet the criteria of enrolling patients with suspected cancer who were biopsy naïve, they did not include the intervention and control as specified in the protocol. Studies were later excluded at data extraction if they failed to meet any of the other criteria specified in the protocol.</p><p>A second set of searches was conducted at the end of the guideline development process for all updated review questions using the original search strategies to capture papers published whilst the guideline was being developed. These searches, which included articles up to August 2018, returned 195 references for this review question. These were screened on title and abstract and no additional relevant references were found.</p><p>Two papers were included after full text screening. Three systematic reviews were identified, however; all were excluded because their included RCTs did not meet the protocol. (See evidence tables for details – <a href="#chd.appe">appendix E</a>).</p></div><div id="chd.s1.1.3.3"><h5>Summary of included studies</h5><p>Overall there were 4 included studies – 2 providing evidence as diagnostic cross sectional studies and 2 providing evidence as randomised control trials.</p><p>For the full evidence tables and full GRADE profiles for included studies, please see <a href="#chd.appe">appendix E</a> and <a href="#chd.appg">appendix G</a>.</p></div><div id="chd.s1.1.3.4"><h5>Excluded studies</h5><p>Details of the studies excluded at full-text review are given in <a href="#chd.apph">appendix H</a> along with a reason for their exclusion.</p></div></div><div id="chd.s1.1.4"><h4>Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdtab3"><a href="/books/NBK576979/table/chd.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figchdtab3" rid-ob="figobchdtab3"><img class="small-thumb" src="/books/NBK576979/table/chd.tab3/?report=thumb" src-large="/books/NBK576979/table/chd.tab3/?report=previmg" alt="Table 3. Summary of studies for diagnosing prostate cancer in people suspected to have prostate cancer (cross-sectional studies)." /></a><div class="icnblk_cntnt"><h4 id="chd.tab3"><a href="/books/NBK576979/table/chd.tab3/?report=objectonly" target="object" rid-ob="figobchdtab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of studies for diagnosing prostate cancer in people suspected to have prostate cancer (cross-sectional studies). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdtab4"><a href="/books/NBK576979/table/chd.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figchdtab4" rid-ob="figobchdtab4"><img class="small-thumb" src="/books/NBK576979/table/chd.tab4/?report=thumb" src-large="/books/NBK576979/table/chd.tab4/?report=previmg" alt="Table 4. Summary of studies for diagnosing prostate cancer in people suspected to have prostate cancer (randomised control studies)." /></a><div class="icnblk_cntnt"><h4 id="chd.tab4"><a href="/books/NBK576979/table/chd.tab4/?report=objectonly" target="object" rid-ob="figobchdtab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary of studies for diagnosing prostate cancer in people suspected to have prostate cancer (randomised control studies). </p></div></div><p>See <a href="#chd.appe">appendix E</a> for full evidence tables.</p></div><div id="chd.s1.1.5"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>See <a href="#chd.appg">appendix G</a> for full GRADE tables.</p></div><div id="chd.s1.1.6"><h4>Economic evidence</h4><p>Standard health economics filters were applied to the clinical search strategy for this review question. In total, 802 references were returned, of which 790 could be confidently excluded on screening of titles and abstracts. The remaining 12 studies were reviewed in full text, and 11 were found not to be relevant. This left 1 unique cost–utility analysis.</p><div id="chd.s1.1.6.1"><h5>Included studies</h5><p>One cost–utility analysis was included.</p></div><div id="chd.s1.1.6.2"><h5>Excluded studies</h5><p>Details of studies excluded after consideration at the full-text stage are provided in <a href="#chd.apph">appendix H</a>.</p></div></div><div id="chd.s1.1.7"><h4>Summary of studies included in the economic evidence review</h4><p>Faria et al. (2018) developed a cost-effectiveness model for lifetime health outcomes and costs, using data captured in PROMIS, a paired-cohort diagnostic study (Ahmed et al., 2017), adopting the perspective of the UK NHS and using 2015 prices. Patients at study entry were people at risk of prostate cancer referred to secondary care for further investigation.</p><p>The study assessed the performance of 3 tests: multi-parametric magnetic resonance imaging (MP-MRI), trans-rectal ultra-sound biopsy (TRUS) and transperineal mapping biopsy (TPMB). In the economic analysis, the combination of TRUS and TPMB, whichever was most severe, was the reference standard. The model examined 383 diagnostic strategies, based on possible sequences of the 3 tests, 2 pathological definitions of clinically significant prostate cancer (CS PC) and different thresholds of Likert score at which prostate cancer is considered clinically significant using MP-MRI.</p><p>A decision tree model was structured to model the diagnostic stage. The long-term stage used a Markov structure to model the lifetime costs and health benefits of people diagnosed with clinically significant (CS), non-clinically significant (NCS) or no cancer (NC), by whether they were correctly classified or not. The Markov model consisted of 2 health states for no cancer: alive or dead, and 3 health states for men with cancer: localised, metastatic and dead.</p><p>Diagnostic accuracy data were obtained from PROMIS, if possible, and also identified from other published literature, as diagnostic accuracy data varied according to the diagnostic test position in the sequence and whether it was combined with other test(s). Risk of mortality and progression included in the long-term model were derived from a clinical trial in the US: Prostate Cancer Intervention Versus Observation Trial (PIVOT). Patients misclassified as no cancer were assigned probability of progression or death observed in the watchful waiting arm, whereas data for those correctly diagnosed with cancer were taken from the radical treatment arm. Cases with underlying prostate cancer, misclassified as having no cancer, were not considered for re-testing; thus, they would stay on active surveillance. The cost effectiveness of a strategy was defined based on number of CS cancer detected for a given pound spent in the diagnostic stage, while the long-term cost effectiveness was defined based on the maximum health outcome achieved given the cost.</p><p>Health-related utilities were derived from EQ-5D questionnaires collected in PROMIS, where TPM directly affected the health-related quality of life, while TRUS and MP-MRI were assumed to have no effect. Disutility, assigned due to aging and progression for health states in the long-run, were identified in published literature.</p><p>When the total expected lifetime cost and effectiveness results of the all 383 strategies were compared with each other, the authors found that only 14 strategies were expected to be cost effective at different values of cost-effectiveness thresholds. The strategy that was found to be optimal (when QALYs are valued at less than £30,000 each) was called “M7 222”:
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<ul><li class="half_rhythm"><div>all people receive MP-MRI</div></li><li class="half_rhythm"><div>people with lesion volume <0.2 cc on MP-MRI and/or assessed by the radiologist as highly likely benign (score 1 on a 5-point Likert scale reflecting probability of malignancy) are judged not to have clinically significant prostate cancer</div></li><li class="half_rhythm"><div>people with lesion volume ≥0.2 cc and/or Gleason score ≥3+4, assessed by the radiologist as ≥2 on the Likert scale undergo MRI-targeted TRUS biopsy
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<ul class="circle"><li class="half_rhythm"><div>people with any Gleason ≥3+4 and/or cancer core length ≥4 mm are diagnosed with clinically significant prostate cancer</div></li><li class="half_rhythm"><div>people not meeting these criteria receive a 2<sup>nd</sup> MRI-targeted TRUS biopsy
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">people with any Gleason ≥3+4 and/or cancer core length ≥4 mm are diagnosed with clinically significant prostate cancer</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">people not meeting these criteria are judged not to have clinically significant prostate cancer</p></dd></dl></dl></div></li></ul></div></li><li class="half_rhythm"><div>template biopsies are not used in this strategy</div></li></ul></p><p>This strategy (which was the 2<sup>nd</sup> most effective of those simulated) had an ICER of £7,076/QALY compared with the next best strategy. The most effective strategy (P4 2-) was for all people to receive TRUS biopsy, after which anyone with negative findings undergoes template biopsy. However, this strategy was associated with an ICER of £30,084/QALY compared with M7 222.</p><p>The results are sensitive to the sensitivity of the 1<sup>st</sup> and 2<sup>nd</sup> MRI-targeted TRUS and the costs of the test. For example, a reduction in the sensitivity assigned to MRI-targeted TRUS resulted in the cost-effectiveness results favouring strategies beginning with TRUS.</p></div><div id="chd.s1.1.8"><h4>Economic model</h4><p>This question was not prioritised for economic modelling.</p></div><div id="chd.s1.1.9"><h4>Evidence statements</h4><p>The evidence statements in these sections are written with reference to the size of the likelihood ratios in the GRADE tables in <a href="#chd.appg">appendix G</a>, using the interpretation detailed in the methods section on diagnostic test accuracy (<a class="figpopup" href="/books/NBK576979/table/chd.appb.tab2/?report=objectonly" target="object" rid-figpopup="figchdappbtab2" rid-ob="figobchdappbtab2">Table 6</a>).</p><div id="chd.s1.1.9.1"><h5>Clinical evidence statements from cross sectional studies</h5><p>Evidence on TRUS biopsy shows that
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<ul><li class="half_rhythm"><div>A positive TRUS biopsy leads to a <b>very large increase</b> in the probability that a person suspected of prostate cancer has clinically significant disease (high quality evidence form 2 prospective studies comprising 626 participants; 95% confidence intervals range from large to very large increase).</div></li><li class="half_rhythm"><div>A negative TRUS biopsy <b>does not meaningfully alter the probability</b> that a person suspected of prostate cancer has clinically significant disease (Moderate-quality evidence from 2 prospective studies comprising 626 participants; 95% confidence intervals range from slight to moderate decrease).</div></li></ul></p><p>Evidence on multiparametric MRI shows that
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<ul><li class="half_rhythm"><div><i>Results that indicate a person suspected of prostate cancer has an increased probability of clinically significant disease (based on positive likelihood ratios)</i>:
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<ul class="circle"><li class="half_rhythm"><div>A score of ≥2 <b>does not alter the probability</b> that a person suspected of prostate cancer has clinically significant disease (high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range from slight decrease to slight increase).</div></li><li class="half_rhythm"><div>A score of ≥3 <b>does not alter the probability</b> that a person suspected of prostate cancer has clinically significant disease (high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range within slight increase).</div></li><li class="half_rhythm"><div>A score of ≥4 leads to a <b>moderate increase</b> in the probability that a person suspected of prostate cancer has clinically significant disease (high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range from slight increase to large increase).</div></li><li class="half_rhythm"><div>A score of ≥5 leads to a <b>large increase</b> in the probability that a person suspected of prostate cancer has clinically significant disease (low-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range from slight increase to very large increase).</div></li></ul></div></li><li class="half_rhythm"><div><i>Results that indicate a person suspected of prostate cancer has a decreased probability of clinically significant disease (based on negative likelihood ratios):</i>
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<ul class="circle"><li class="half_rhythm"><div>A score of <2 leads to a <b>moderate decrease</b> in the probability that a person suspected of prostate cancer has clinically significant disease high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range from slight to large decrease).</div></li><li class="half_rhythm"><div>A score of <3 leads to a <b>large decrease</b> in the probability that a person suspected of prostate cancer has clinically significant disease (high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range from moderate to large decrease).</div></li><li class="half_rhythm"><div>A score of <4 leads to a <b>moderate decrease</b> in the probability that a person suspected of prostate cancer has clinically significant disease (high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range within moderate decrease).</div></li><li class="half_rhythm"><div>A score of <5 does <b>not alter the probability</b> that a person suspected of prostate cancer has clinically significant disease (high-quality evidence from 1 prospective study comprising 576 participants; 95% confidence intervals range within slight decrease).</div></li></ul></div></li></ul></p></div><div id="chd.s1.1.9.2"><h5>Clinical evidence statements from randomised control studies</h5><div id="chd.s1.1.9.2.1"><h5>MRI influenced TRUS biopsy versus systematic TRUS biopsy</h5><p>Very low-quality evidence from 2 RCTs including 712 people who are biopsy naïve and suspected of having prostate cancer shows that MRI-influenced-prostate biopsy finds more people with clinically significant cancer than systematic prostate biopsy.</p><p>High-quality evidence from 2 RCTs including 712 people who are biopsy naïve and suspected of having prostate cancer shows that MRI-influenced prostate biopsy finds less people with clinically insignificant cancer than systematic prostate biopsy.</p><p>High-quality evidence from 2 RCT including 456 people who are biopsy naïve and suspected of having prostate cancer shows that using a strategy which includes MRI as first line treatment may lead to a quarter of people avoiding repeat biopsy.</p><p>Low-quality evidence from 1 RCT including 500 people who are biopsy naïve and suspected of having prostate cancer could not differentiate investigator-reported adverse events (sepsis, haematuria and prostatitis) between people who had MRI-influenced-prostate biopsy and those who had systematic prostate biopsy.</p><p>High-quality evidence from 1 RCT including 500 people who are biopsy naïve and suspected of having prostate cancer shows there is no difference in health-related quality of life between people having MRI-influenced-prostate biopsy and those having systematic prostate biopsy at 24 hours and at 30 days post biopsy.</p><p>Moderate- to high-quality evidence from 1 RCT reporting data on 418 people who are biopsy naïve and suspected of having prostate cancer found fewer people who had MRI-influenced-biopsy reported blood in the urine, blood in semen and pain at site of procedure than those who had systematic TRUS-guided biopsy. However, the evidence could not differentiate the number of people experiencing other adverse events such as erectile dysfunction, urinary tract infection, prostatitis and urinary incontinence between the 2 groups.</p></div><div id="chd.s1.1.9.2.2"><h5>Economic evidence statement</h5><p>One directly applicable cost–utility analysis with minor limitations found that the optimal diagnostic strategy is for all people to receive MP-MRI followed by up to 2 MRI-targeted TRUS biopsies for those with positive findings. This strategy was associated with an ICER of £7,076/QALY compared with the next-best option.</p></div></div></div><div id="chd.s1.1.10"><h4>The committee’s discussion of the evidence</h4><div id="chd.s1.1.10.1"><h5>Interpreting the evidence</h5><div id="chd.s1.1.10.1.1"><h5>The outcomes that matter most</h5><p>The committee was interested in negative and positive predictive values as this is what they were familiar with. The development team explained the limitations associated with reporting evidence in terms of negative and positive predictive values as they depend on the prevalence of disease within the study population. As a result, likelihood ratios were deemed to be the superior option and thus the outcome of most importance when considering diagnostic test studies</p><p>When considering evidence from randomised control studies, the committee was interested in the proportion of people with clinically significant cancer following MRI influenced biopsy. This was because there was no evidence for MRI incluenced biopsy from the diagnostic test accuracy studies.</p></div><div id="chd.s1.1.10.1.2"><h5>The quality of the evidence</h5><p>The 2 included studies for diagnostic test accuracy were of moderate quality (Nafie et al. 2014) owing to unclear patient selection or low risk of bias (Ahmed et al. 2017). The committee acknowledged that this was an area with new emerging evidence, therefore they were not surprised by the limited amount of studies. Both of the studies were prospective cross-sectional studies from the UK.</p><p>The PROMIS study (Ahmed et al. 2017), is a well conducted large UK diagnostic accuracy study with a large population of 576 participants. This study contributed evidence for both TRUS biopsy and multiparametric-MRI. The study by Nafie et al. (2014) was also well conducted but with a smaller sample size investigating the diagnostic accuracy of TRUS biopsy. As a result only 1 study contributed to the evidence on multiparametric-MRI (Ahmed et al. (2017) and 2 studies on TRUS biopsy (Ahmed et al. (2017) and Nafie et al. (2014)).</p><p>There were no diagnostic test accuracy studies included addressing MRI influenced prostate biopsy. As a result the committee was also presented with evidence from diagnostic randomised control trial studies.</p><p>Initially 5 studies were included, however the committee agreed that 3 of the studies Baco et al. (2016), Park et al.(2011) and Tontilla et al. (2016), were out of date as their study periods were almost 10 years ago. The committee noted that MRI technology has changed significantly since then and they were only interested in the most recent studies that reflect current practice. Though the Baco et al. and Tontilla et al. studies were published in 2016, the studies were started in 2011, the committee explained that, the technology during that period has changed considerably. This resulted in the review of 2 papers Kasivisnathan et al. (2018) (also referred to as the PRECISION study) and Porpiglia et al. (2017).</p><p>These 2 studies were graded as having low risk of bias. The PRECISION study (Kasivisvanathan et al. (2018) is a UK study and Porpiglia et al. (2017) is an Italian study. Both studies provided evidence for MRI influenced prostate biopsy. The committee opted for the term “prostate biopsy” because some of the participants from the Kasivisnathan et al. (2018) study had biopsy taken via the transperineal route and not the transrectal route, the committee noted that “prostate biopsy” encompasses both terms. There currently is limited evidence on the efficacy of transperineal (not mapping biopsy), for the purposes of this review performance of transperineal route was assumed to be similar to that of transrectal route biopsy.</p></div><div id="chd.s1.1.10.1.3"><h5>Benefits and harms</h5><div id="chd.s1.1.10.1.3.1"><h5>Clinical effectiveness</h5><p>Based on the evidence, the committee recommended multiparametric MRI as the first-line investigation for people with suspected clinically localised prostate cancer. Evidence from the PRECISION study (Kasivisvanathan et al. (2018) and Porpiglia et al. (2017) showed that more people with clinically significant cancers were likely to be identified if they had MRI influenced biopsy than if they received prostate biopsy alone.</p><p>The PRECISION study (Kasivisvanathan et al. (2018) carried out MRI-influenced prostate biopsy in those people whose multiparametric-MRI Likert score was 3 or above; however, PROMIS (Ahmed et al., 2017) and the Porpiglia et al. (2017) trial provided evidence that there is a risk that clinically significant cancers may be missed if a cutoff of Likert 3 is used to classify MRI findings. As a result, the committee made ‘consider’ recommendations to omit prostate biopsy in people with a multiparametric-MRI Likert score of 1 or 2. The committee stressed that, for those with a MRI Likert score of 1 or 2, there should be a discussion of risks and benefits before reaching a shared decision. As a result, a preference decision point was developed to help clinicians explain advantages and disadvantages of undergoing TRUS biopsy in people with low-risk MRI findings. To inform this advice, data on the accuracy of MRI and the accuracy of TRUS biopsy in people with low-risk MRI findings were obtained from the PROMIS trial (previously unpublished data on the sensitivity of TRUS biopsy stratified by MRI findings were provided by the PROMIS investigators; for details, see table HE05 in Health economics report). Data on the adverse events associated with TRUS biopsy were derived from the ProtecT RCT (Rosario et al., 2012). To use these data, it was assumed that
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<ul><li class="half_rhythm"><div>both tests (multiparametric MRI and TRUS biopsy) will perform similarly in practice as they did in the PROMIS trial, and</div></li><li class="half_rhythm"><div>the population recruited for the study is representative of people who are suspected of prostate cancer in practice; in particular, there is a similar prevalence of clinically significant prostate cancer among PROMIS participants as there is in the population that would be considered for testing in practice. This assumption is important, as the information the committee suggest should be used to guide decision-making includes data derived from predictive values. These will only be valid for populations with the same underlying prevalence of disease as the cohort in the study. However, the committee agreed that, because it was undertaken in the UK and had broad eligibility criteria, PROMIS is a good source of evidence on the true prevalence of clinically significant prostate cancer (when measured using a reliable standard – TPM biopsy) as well as on the performance of MRI and TRUS biopsy. Therefore, the committee was content that predictive values from PROMIS should have a good degree of applicability in NHS practice.</div></li></ul></p><p>Evidence from the PROMIS study showed that a multiparametric- MRI Likert score of less than 3 leads to a large decrease in the probability that a person suspected of prostate cancer has clinically significant disease, as a result the committee recommended that multiparametric MRI - influenced prostate biopsy should be offered in people whose multiparametric-MRI Likert score is 3 or more.</p><p>Considering the accuracy of multiparametric MRI, the committee made a ‘do not offer’ recommendation on the use of mapping transperineal template biopsy as an initial assessment. The committee explained that this type of biopsy is very invasive requiring patients to be under general anaesthetics, and requiring at least 24 samples to be taken. It also explained that transperineal template biopsy is resource intensive and the NHS is not equipped to perform large numbers of these. The committee was also concerned by the potential for over diagnosis and high numbers of clinically non-significant disease are identified.</p><p>The committee did not change the existing recommendation that imaging should not be offered to people who are not suitable for for radical treatment because no new evidence was found that affects current recommended practice.</p></div><div id="chd.s1.1.10.1.3.2"><h5>Cost effectiveness</h5><p>The committee reviewed the included economic evidence. It agreed that the included cost-utility analysis provided directly applicable evidence, as it was based on a UK RCT (PROMIS). The committee noted some limitations of the analyses, particularly that the MRI-influenced biopsy technique was not explicitly explained, which affected the sensitivity parameter assigned to this test. In addition, there was a high degree of uncertainty around the cost-effectiveness of the long-term treatment, in particular for those with low-risk prostate cancer. This influenced the selection of the MP-MRI cut-off point at which patient were directed to biopsy. However, the committee were shown the two-way sensitivity analysis that assessed the impact of changes in two parameters: the relative sensitivity of the MRI-influenced biopsy and its cost. They were convinced that the optimal strategy suggested by PROMIS economic study was maintained within plausible ranges.</p><p>The committee agreed that limitations of the economic evidence provided by PROMIS would not alter its conclusion. Thus it concluded that the data provided by PROMIS are sufficient to underpin its recommendation about considering the diagnostic strategy suggested by PROMIS and found to be the most optimal in diagnosing prostate cancer.</p></div></div></div><div id="chd.s1.1.10.2"><h5>Other factors the committee took into account</h5><p>The committee discussed the term ‘clinically significant cancer’ and agreed that there was no universally agreed definition of the term. The definition used in this review generally meant cancer of Gleason 7 or greater as reported by the included studies.</p><p>The committee also discussed whether or not there should be a specific mention of which contrast enhancement agent to use with multiparametric MRI. The committee decided to leave this decision with the imaging centres and specified that the MRI protocol should be multiparametric – which includes at least 1.5 Tesla, diffusion weighted, contrast- enhanced imaging and b value of at least 800.</p></div></div></div></div><div id="appendixes.appgroupd"><h2 id="_appendixes_appgroupd_">Appendices</h2><div id="chd.appa"><h3>Appendix A. Review protocols</h3><div id="chd.appa.s1"><h4>RQ1. Review protocol for prostate cancer diagnosis in men with suspected prostate (diagnostic cross-sectional studies)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappatab1"><a href="/books/NBK576979/table/chd.appa.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappatab1" rid-ob="figobchdappatab1"><img class="small-thumb" src="/books/NBK576979/table/chd.appa.tab1/?report=thumb" src-large="/books/NBK576979/table/chd.appa.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appa.tab1"><a href="/books/NBK576979/table/chd.appa.tab1/?report=objectonly" target="object" rid-ob="figobchdappatab1">Table</a></h4><p class="float-caption no_bottom_margin">Multiparametric or biparametric MRI alone MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</p></div></div></div><div id="chd.appa.s2"><h4>RQ1a. Review protocol for prostate cancer diagnosis in men with suspected prostate (randomised control studies)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappatab2"><a href="/books/NBK576979/table/chd.appa.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappatab2" rid-ob="figobchdappatab2"><img class="small-thumb" src="/books/NBK576979/table/chd.appa.tab2/?report=thumb" src-large="/books/NBK576979/table/chd.appa.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appa.tab2"><a href="/books/NBK576979/table/chd.appa.tab2/?report=objectonly" target="object" rid-ob="figobchdappatab2">Table</a></h4><p class="float-caption no_bottom_margin">Multiparametric or biparametric MRI alone MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</p></div></div></div></div><div id="chd.appb"><h3>Appendix B. Methods</h3><div id="chd.appb.s1"><h4>Incorporating published systematic reviews</h4><p>For all review questions where a literature search was undertaken looking for a particular study design, systematic reviews containing studies of that design were also included. All included studies from those systematic reviews were screened to identify any additional relevant primary studies not found as part of the initial search.</p></div><div id="chd.appb.s2"><h4>Evidence of effectiveness of interventions</h4><div id="chd.appb.s2.1"><h5>Quality assessment</h5><p>Individual RCTs and quasi-randomised controlled trials were quality assessed using the Cochrane Risk of Bias Tool. Each individual study was classified into one of the following three groups:
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<ul><li class="half_rhythm"><div>Low risk of bias – The true effect size for the study is likely to be close to the estimated effect size.</div></li><li class="half_rhythm"><div>Moderate risk of bias – There is a possibility the true effect size for the study is substantially different to the estimated effect size.</div></li><li class="half_rhythm"><div>High risk of bias – It is likely the true effect size for the study is substantially different to the estimated effect size.</div></li></ul></p><p>Each individual study was also classified into one of three groups for directness, based on if there were concerns about the population, intervention, comparator and/or outcomes in the study and how directly these variables could address the specified review question. Studies were rated as follows:
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<ul><li class="half_rhythm"><div>Direct – No important deviations from the protocol in population, intervention, comparator and/or outcomes.</div></li><li class="half_rhythm"><div>Partially indirect – Important deviations from the protocol in one of the population, intervention, comparator and/or outcomes.</div></li><li class="half_rhythm"><div>Indirect – Important deviations from the protocol in at least two of the following areas: population, intervention, comparator and/or outcomes.</div></li></ul></p></div><div id="chd.appb.s2.2"><h5>Methods for combining intervention evidence</h5><p>Meta-analyses of interventional data were conducted with reference to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins et al. 2011).</p><p>Where different studies presented continuous data measuring the same outcome but using different numerical scales (e.g. a 0-10 and a 0-100 visual analogue scale), these outcomes were all converted to the same scale before meta-analysis was conducted on the mean differences. Where outcomes measured the same underlying construct but used different instruments/metrics, data were analysed using standardised mean differences (Hedges’ g).</p><p>A pooled relative risk was calculated for dichotomous outcomes (using the Mantel–Haenszel method). Both relative and absolute risks were presented, with absolute risks calculated by applying the relative risk to the pooled risk in the comparator arm of the meta-analysis.</p><p>Fixed- and random-effects models (der Simonian and Laird) were fitted for all syntheses, with the presented analysis dependent on the degree of heterogeneity in the assembled evidence. Fixed-effects models were the preferred choice to report, but in situations where the assumption of a shared mean for fixed-effects model were clearly not met, even after appropriate pre-specified subgroup analyses were conducted, random-effects results are presented. Fixed-effects models were deemed to be inappropriate if one or both of the following conditions was met:
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<ul><li class="half_rhythm"><div>Significant between study heterogeneity in methodology, population, intervention or comparator was identified by the reviewer in advance of data analysis. This decision was made and recorded before any data analysis was undertaken.</div></li><li class="half_rhythm"><div>The presence of significant statistical heterogeneity in the meta-analysis, defined as I<sup>2</sup>≥50%.</div></li></ul></p><p>In any meta-analyses where some (but not all) of the data came from studies at high risk of bias, a sensitivity analysis was conducted, excluding those studies from the analysis. Results from both the full and restricted meta-analyses are reported. Similarly, in any meta-analyses where some (but not all) of the data came from indirect studies, a sensitivity analysis was conducted, excluding those studies from the analysis.</p><p>Meta-analyses were performed in Cochrane Review Manager v5.3.</p></div><div id="chd.appb.s2.3"><h5>Minimal clinically important differences (MIDs)</h5><p>The Core Outcome Measures in Effectiveness Trials (COMET) database was searched to identify published minimal clinically important difference thresholds relevant to this guideline. Identified MIDs were assessed to ensure they had been developed and validated in a methodologically rigorous way, and were applicable to the populations, interventions and outcomes specified in this guideline. In addition, the Guideline Committee were asked to prospectively specify any outcomes where they felt a consensus MID could be defined from their experience. In particular, any questions looking to evaluate non-inferiority (that one treatment is not meaningfully worse than another) required an MID to be defined to act as a non-inferiority margin.</p><p>For standardised mean differences where no other MID was available, an MID of 0.2 was used, corresponding to the threshold for a small effect size initially suggested by Cohen et al. (1988). For relative risks where no other MID was available, a default MID interval for dichotomous outcomes of 0.8 to 1.25 was used.</p><p>When decisions were made in situations where MIDs were not available, the ‘Evidence to Recommendations’ section of that review should make explicit the committee’s view of the expected clinical importance and relevance of the findings. In particular, this includes consideration of whether the whole effect of a treatment (which may be felt across multiple independent outcome domains) would be likely to be clinically meaningful, rather than simply whether each individual sub outcome might be meaningful in isolation.</p></div><div id="chd.appb.s2.4"><h5>GRADE for pairwise meta-analyses of interventional evidence</h5><p>GRADE was used to assess the quality of evidence for the selected outcomes as specified in ‘Developing NICE guidelines: the manual (2014)’. Data from RCTs was initially rated as high quality and the quality of the evidence for each outcome was downgraded or not from this initial point. If non-RCT evidence was included for intervention-type systematic reviews then these were initially rated as either moderate quality (quasi-randomised studies) or low quality (cohort studies) and the quality of the evidence for each outcome was further downgraded or not from this point, based on the criteria given in <a class="figpopup" href="/books/NBK576979/table/chd.appb.tab1/?report=objectonly" target="object" rid-figpopup="figchdappbtab1" rid-ob="figobchdappbtab1">Table 5</a></p><p id="chd.appb.tab1"><a href="/books/NBK576979/table/chd.appb.tab1/?report=objectonly" target="object" rid-ob="figobchdappbtab1" class="figpopup">Table 5. Rationale for downgrading quality of evidence for intervention studies</a></p><p>The quality of evidence for each outcome was upgraded if any of the following three conditions were met:
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<ul><li class="half_rhythm"><div>Data from non-randomised studies showing an effect size sufficiently large that it cannot be explained by confounding alone.</div></li><li class="half_rhythm"><div>Data showing a dose-response gradient.</div></li><li class="half_rhythm"><div>Data where all plausible residual confounding is likely to increase our confidence in the effect estimate.</div></li></ul></p></div><div id="chd.appb.s2.5"><h5>Publication bias</h5><p>Publication bias was assessed in two ways. First, if evidence of conducted but unpublished studies was identified during the review (e.g. conference abstracts, trial protocols or trial records without accompanying published data), available information on these unpublished studies was reported as part of the review. Secondly, where 10 or more studies were included as part of a single meta-analysis, a funnel plot was produced to graphically assess the potential for publication bias.</p></div><div id="chd.appb.s2.6"><h5>Evidence statements</h5><p>Evidence statements for pairwise intervention data are classified in to one of four categories:
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<ul><li class="half_rhythm"><div>Situations where the data are only consistent, at a 95% confidence level, with an effect in one direction (i.e. one that is ‘statistically significant’), and the magnitude of that effect is most likely to meet or exceed the MID (i.e. the point estimate is not in the zone of equivalence). In such cases, we state that the evidence showed that there is an effect.</div></li><li class="half_rhythm"><div>Situations where the data are only consistent, at a 95% confidence level, with an effect in one direction (i.e. one that is ‘statistically significant’), but the magnitude of that effect is most likely to be less than the MID (i.e. the point estimate is in the zone of equivalence). In such cases, we state that the evidence could not demonstrate a meaningful difference.</div></li><li class="half_rhythm"><div>Situations where the data are consistent, at a 95% confidence level, with an effect in either direction (i.e. one that is not ‘statistically significant’) but the confidence limits are smaller than the MIDs in both directions. In such cases, we state that the evidence demonstrates that there is no difference.</div></li><li class="half_rhythm"><div>In all other cases, we state that the evidence could not differentiate between the comparators.</div></li></ul></p><p>For outcomes without a defined MID or where the MID is set as the line of no effect (for example, in the case of mortality), evidence statements are divided into 2 groups as follows:
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<ul><li class="half_rhythm"><div>We state that the evidence showed that there is an effect if the 95% CI does not cross the line of no effect.</div></li><li class="half_rhythm"><div>We state the evidence could not differentiate between comparators if the 95% CI crosses the line of no effect.</div></li></ul></p><p>The number of trials and participants per outcome are detailed in the evidence statements, but in cases where there are several outcomes being summarised in a single evidence statement and the numbers of participants and trials differ between outcomes, then the number of trials and participants stated are taken from the outcome with the largest number of trials. This is denoted using the terminology ‘up to’ in front of the numbers of trials and participants.</p><p>The evidence statements also cover the quality of the outcome based on the GRADE table entry. These can be included as single ratings of quality or go from one quality level to another if multiple outcomes with different quality ratings are summarised by a single evidence statement</p></div></div><div id="chd.appb.s3"><h4>Diagnostic test accuracy evidence</h4><p>In this guideline, diagnostic test accuracy (DTA) data are classified as any data in which a feature – be it a symptom, a risk factor, a test result or the output of some algorithm that combines many such features – is observed in some people who have the condition of interest at the time of the test and some people who do not. Such data either explicitly provide, or can be manipulated to generate, a 2x2 classification of true positives and false negatives (in people who, according to the reference standard, truly have the condition) and false positives and true negatives (in people who, according to the reference standard, do not).</p><p>The ‘raw’ 2x2 data can be summarised in a variety of ways. Those that were used for decision making in this guideline are as follows:
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<ul><li class="half_rhythm"><div><b>Positive likelihood ratios</b> describe how many times more likely positive features are in people with the condition compared to people without the condition. Values greater than 1 indicate that a positive result makes the condition more likely.</div><ul class="circle"><li class="half_rhythm"><div>LR<sup>+</sup> = (TP/[TP+FN])/(FP/[FP+TN])</div></li></ul></li><li class="half_rhythm"><div><b>Negative likelihood ratios</b> describe how many times less likely negative features are in people with the condition compared to people without the condition. Values less than 1 indicate that a negative result makes the condition less likely.</div><ul class="circle"><li class="half_rhythm"><div>LR<sup>-</sup> = (FN/[TP+FN])/(TN/[FP+TN])</div></li></ul></li><li class="half_rhythm"><div><b>Sensitivity</b> is the probability that the feature will be positive in a person with the condition.</div><ul class="circle"><li class="half_rhythm"><div>sensitivity = TP/(TP+FN)</div></li></ul></li><li class="half_rhythm"><div><b>Specificity</b> is the probability that the feature will be negative in a person without the condition.</div><ul class="circle"><li class="half_rhythm"><div>specificity = TN/(FP+TN)</div></li></ul></li></ul></p><p>The following schema, adapted from the suggestions of Jaeschke et al. (1994), was used to interpret the likelihood ratio findings from diagnostic test accuracy reviews.</p><p id="chd.appb.tab2"><a href="/books/NBK576979/table/chd.appb.tab2/?report=objectonly" target="object" rid-ob="figobchdappbtab2" class="figpopup">Table 6. Interpretation of likelihood ratios</a></p><p>The schema above has the effect of setting a minimal important difference for positive likelihoods ratio at 2, and a corresponding minimal important difference for negative likelihood ratios at 0.5. Likelihood ratios (whether positive or negative) falling between these thresholds were judged to indicate no meaningful change in the probability of disease.</p><div id="chd.appb.s3.1"><h5>Quality assessment</h5><p>Individual studies were quality assessed using the QUADAS-2 tool, which contains four domains: patient selection, index test, reference standard, and flow and timing. Each individual study was classified into one of the following two groups:
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<ul><li class="half_rhythm"><div>Low risk of bias – Evidence of non-serious bias in zero or one domain.</div></li><li class="half_rhythm"><div>Moderate risk of bias – Evidence of non-serious bias in two domains only, or serious bias in one domain only.</div></li><li class="half_rhythm"><div>High risk of bias – Evidence of bias in at least three domains, or of serious bias in at least two domains.</div></li></ul></p><p>Each individual study was also classified into one of three groups for directness, based on if there were concerns about the population, index features and/or reference standard in the study and how directly these variables could address the specified review question. Studies were rated as follows:
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<ul><li class="half_rhythm"><div>Direct – No important deviations from the protocol in population, index feature and/or reference standard.</div></li><li class="half_rhythm"><div>Partially indirect – Important deviations from the protocol in one of the population, index feature and/or reference standard.</div></li><li class="half_rhythm"><div>Indirect – Important deviations from the protocol in at least two of the population, index feature and/or reference standard.</div></li></ul></p></div><div id="chd.appb.s3.2"><h5>Methods for combining diagnostic test accuracy evidence</h5><p>Meta-analysis of diagnostic test accuracy data was conducted with reference to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy (Deeks et al. 2010).</p><p>Where applicable, diagnostic syntheses were stratified by:
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<ul><li class="half_rhythm"><div>Presenting symptomatology (features shared by all participants in the study, but not all people who could be considered for a diagnosis in clinical practice).</div></li><li class="half_rhythm"><div>The reference standard used for true diagnosis.</div></li></ul></p><p>Where five or more studies were available for all included strata, a bivariate model was fitted using the mada package in R v3.4.0, which accounts for the correlations between positive and negative likelihood ratios, and between sensitivities and specificities. Where sufficient data were not available (2-4 studies), separate independent pooling was performed for positive likelihood ratios, negative likelihood ratios, sensitivity and specificity, using Microsoft Excel. This approach is conservative as it is likely to somewhat underestimate test accuracy, due to failing to account for the correlation and trade-off between sensitivity and specificity (see Deeks 2010).</p><p>Random-effects models (der Simonian and Laird) were fitted for all syntheses, as recommended in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy (Deeks et al. 2010).</p><p>In any meta-analyses where some (but not all) of the data came from studies at high risk of bias, a sensitivity analysis was conducted, excluding those studies from the analysis. Results from both the full and restricted meta-analyses are reported. Similarly, in any meta-analyses where some (but not all) of the data came from indirect studies, a sensitivity analysis was conducted, excluding those studies from the analysis.</p></div><div id="chd.appb.s3.3"><h5>Modified GRADE for diagnostic test accuracy evidence</h5><p>GRADE has not been developed for use with diagnostic studies; therefore a modified approach was applied using the GRADE framework. GRADE assessments were only undertaken for positive and negative likelihood ratios, as the MIDs used to assess imprecision were based on these outcomes, but results for sensitivity and specificity are also presented alongside those data.</p><p>Cross-sectional and cohort studies were initially rated as high-quality evidence if well conducted, and then downgraded according to the standard GRADE criteria (risk of bias, inconsistency, imprecision and indirectness) as detailed in <a class="figpopup" href="/books/NBK576979/table/chd.appb.tab3/?report=objectonly" target="object" rid-figpopup="figchdappbtab3" rid-ob="figobchdappbtab3">Table 7</a> below.</p><p id="chd.appb.tab3"><a href="/books/NBK576979/table/chd.appb.tab3/?report=objectonly" target="object" rid-ob="figobchdappbtab3" class="figpopup">Table 7. Rationale for downgrading quality of evidence for diagnostic questions</a></p><p>The quality of evidence for each outcome was upgraded if either of the following conditions were met:
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<ul><li class="half_rhythm"><div>Data showing an effect size sufficiently large that it cannot be explained by confounding alone.</div></li><li class="half_rhythm"><div>Data where all plausible residual confounding is likely to increase our confidence in the effect estimate.</div></li></ul></p></div><div id="chd.appb.s3.4"><h5>Publication bias</h5><p>Publication bias was assessed in two ways. First, if evidence of conducted but unpublished studies was identified during the review (e.g. conference abstracts or protocols without accompanying published data), available information on these unpublished studies was reported as part of the review. Secondly, where 10 or more studies were included as part of a single meta-analysis, a funnel plot was produced to graphically assess the potential for publication bias.</p></div><div id="chd.appb.s3.5"><h5>Methods for combining inter-rater agreement evidence</h5><p>The reliability of agreement for diagnostic data between observers was evaluated using the kappa coefficient. The measure calculates the level of agreement in classification. The general rule of thumb to follow is: if there is no agreement among the classification, then kappa ≤0; if there is complete agreement then kappa=1 (Fleiss 1971). The following schema (see <a class="figpopup" href="/books/NBK576979/table/chd.appb.tab4/?report=objectonly" target="object" rid-figpopup="figchdappbtab4" rid-ob="figobchdappbtab4">Table 8</a>), adapted from the suggestions of Fleiss, was used to interpret the level of agreement in diagnostic classification. Random-effects models (der Simonian and Laird) were fitted for all syntheses in R v3.4.0.</p><p>In any meta-analyses where some (but not all) of the data came from studies at high risk of bias, a sensitivity analysis was conducted, excluding those studies from the analysis. Results from both the full and restricted meta-analyses are reported. Similarly, in any meta-analyses where some (but not all) of the data came from indirect studies, a sensitivity analysis was conducted, excluding those studies from the analysis.</p><p id="chd.appb.tab4"><a href="/books/NBK576979/table/chd.appb.tab4/?report=objectonly" target="object" rid-ob="figobchdappbtab4" class="figpopup">Table 8. Interpretation of kappa coefficient</a></p></div><div id="chd.appb.s3.6"><h5>Modified GRADE for inter-rater agreement evidence</h5><p>GRADE has not been developed for use with inter-rater agreement; therefore a modified approach was applied using the GRADE framework. Data from all study types was initially rated as high quality, with the quality of the evidence for each outcome then downgraded or not from this initial point.</p><p id="chd.appb.tab5"><a href="/books/NBK576979/table/chd.appb.tab5/?report=objectonly" target="object" rid-ob="figobchdappbtab5" class="figpopup">Table 9. Rationale for downgrading evidence for inter-rater agreement</a></p></div></div></div><div id="chd.appc"><h3>Appendix C. Literature search strategies</h3><div id="chd.appc.s1"><h4>Search summary</h4><p>The search strategies are based on the review protocol provided. The MRI/biopsy terms have been taken from the search strategy used in CG175.</p></div><div id="chd.appc.s2"><h4>Clinical searches</h4><p>Source searched for this review question:
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<ul><li class="half_rhythm"><div>Cochrane Database of Systematic Reviews – CDSR (Wiley)</div></li><li class="half_rhythm"><div>Cochrane Central Register of Controlled Trials – CENTRAL (Wiley)</div></li><li class="half_rhythm"><div>Database of Abstracts of Reviews of Effects – DARE (Wiley)</div></li><li class="half_rhythm"><div>Health Technology Assessment Database – HTA (Wiley)</div></li><li class="half_rhythm"><div>EMBASE (Ovid)</div></li><li class="half_rhythm"><div>MEDLINE (Ovid)</div></li><li class="half_rhythm"><div>MEDLINE In-Process (Ovid)</div></li></ul></p><p>The clinical searches were conducted in January 2018.</p><p>The MEDLINE search strategy is presented below. It was translated for use in all other databases.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappctab1"><a href="/books/NBK576979/table/chd.appc.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappctab1" rid-ob="figobchdappctab1"><img class="small-thumb" src="/books/NBK576979/table/chd.appc.tab1/?report=thumb" src-large="/books/NBK576979/table/chd.appc.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appc.tab1"><a href="/books/NBK576979/table/chd.appc.tab1/?report=objectonly" target="object" rid-ob="figobchdappctab1">Table</a></h4></div></div></div><div id="chd.appc.s3"><h4>Study design filters and limits</h4><p>A diagnostic filter was appended to the review question above. The MEDLINE filter is presented below. It were translated for use in the MEDLINE In-Process and Embase databases.</p><p>An English language limit has been applied.</p><p>A date limit from 2007 was applied as the committee members were confident we would unlikely find studies on MRI guided biopsy prior to 2007 that reflect current practice.</p><p>Animal studies and certain publication types (letters, historical articles, comments, editorials, news and case reports) have been excluded.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappctab2"><a href="/books/NBK576979/table/chd.appc.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappctab2" rid-ob="figobchdappctab2"><img class="small-thumb" src="/books/NBK576979/table/chd.appc.tab2/?report=thumb" src-large="/books/NBK576979/table/chd.appc.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appc.tab2"><a href="/books/NBK576979/table/chd.appc.tab2/?report=objectonly" target="object" rid-ob="figobchdappctab2">Table</a></h4></div></div></div><div id="chd.appc.s4"><h4>Health Economics search strategy</h4><p>Economic evaluations and quality of life data.</p><p>Sources searched:
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<ul><li class="half_rhythm"><div>NHS Economic Evaluation Database – NHS EED (Wiley) (legacy database)</div></li><li class="half_rhythm"><div>Health Technology Assessment (HTA Database)</div></li><li class="half_rhythm"><div>EconLit (Ovid)</div></li><li class="half_rhythm"><div>Embase (Ovid)</div></li><li class="half_rhythm"><div>MEDLINE (Ovid)</div></li><li class="half_rhythm"><div>MEDLINE In-Process (Ovid)</div></li></ul></p><p>Search filters to retrieve economic evaluations and quality of life papers were appended to population search terms in MEDLINE, MEDLINE In-Process and Embase to identify relevant evidence and can be seen below.</p><p>An English language limit has been applied.</p><p>A date limit from 2007 was applied as the committee members were confident we would unlikely find studies on MRI guided biopsy prior to 2007 that reflect current practice.</p><p>Animal studies and certain publication types (letters, historical articles, comments, editorials, news and case reports) have been excluded.</p><p>The economic searches were conducted in February 2018.</p></div><div id="chd.appc.s5"><h4>Health Economics filters</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappctab3"><a href="/books/NBK576979/table/chd.appc.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappctab3" rid-ob="figobchdappctab3"><img class="small-thumb" src="/books/NBK576979/table/chd.appc.tab3/?report=thumb" src-large="/books/NBK576979/table/chd.appc.tab3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appc.tab3"><a href="/books/NBK576979/table/chd.appc.tab3/?report=objectonly" target="object" rid-ob="figobchdappctab3">Table</a></h4></div></div></div></div><div id="chd.appd"><h3>Appendix D. Clinical evidence study selection</h3><div id="chd.appd.s1"><h4>Clinical evidence – Diagnostic Cross sectional studies</h4><div id="chd.appd.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappdf1&p=BOOKS&id=576979_chdappdf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappdf1.jpg" alt="Image chdappdf1" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appd.s2"><h4>Clinical evidence - Randomised control studies</h4><div id="chd.appd.fig2" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappdf2&p=BOOKS&id=576979_chdappdf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappdf2.jpg" alt="Image chdappdf2" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appd.s3"><h4>Economic evidence</h4><div id="chd.appd.fig3" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappdf3&p=BOOKS&id=576979_chdappdf3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappdf3.jpg" alt="Image chdappdf3" class="tileshop" title="Click on image to zoom" /></a></div></div></div></div><div id="chd.appe"><h3>Appendix E. evidence tables</h3><div id="chd.appe.s1"><h4>Clinical evidence tables</h4><div id="chd.appe.s1.1"><h5>Diagnosing prostate cancer in people suspected to have prostate cancer (diagnostic cross-sectional studies)</h5><p id="chd.appe.et1"><a href="/books/NBK576979/bin/chd-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Studies on Multiparametric MRI compared to Transperineal Template Biopsy</a><span class="small"> (PDF, 197K)</span></p><p id="chd.appe.et2"><a href="/books/NBK576979/bin/chd-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Diagnosing prostate cancer in people suspected to have prostate cancer (RCTs)</a><span class="small"> (PDF, 219K)</span></p><p id="chd.appe.et3"><a href="/books/NBK576979/bin/chd-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economics</a><span class="small"> (PDF, 334K)</span></p></div></div></div><div id="chd.appf"><h3>Appendix F. Forest plots</h3><div id="chd.appf.s1"><h4>Diagnosing prostate cancer in people suspected to have prostate cancer – cross-sectional studies</h4><div id="chd.appf.s1.1"><h5>TRUS biopsy compared to Transperineal Template Biopsy – Sensitivity and specificity for clinically significant cancer</h5><div id="chd.appf.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff1&p=BOOKS&id=576979_chdappff1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff1.jpg" alt="Image chdappff1" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appf.s1.2"><h5>TRUS biopsy compared to Transperineal Template Biopsy - Likelihood ratios for clinically significant cancer</h5><div id="chd.appf.fig2" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff2&p=BOOKS&id=576979_chdappff2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff2.jpg" alt="Image chdappff2" class="tileshop" title="Click on image to zoom" /></a></div></div></div></div><div id="chd.appf.s2"><h4>Diagnosing prostate cancer in people suspected to have prostate cancer – randomised control studies</h4><div id="chd.appf.s2.1"><h5>MRI influenced Biopsy versus TRUS biopsy – Proportion of people with clinically significant cancer</h5><div id="chd.appf.fig3" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff3&p=BOOKS&id=576979_chdappff3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff3.jpg" alt="Image chdappff3" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appf.s2.2"><h5>Proportion of people with clinically insignificant cancer</h5><div id="chd.appf.fig4" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff4&p=BOOKS&id=576979_chdappff4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff4.jpg" alt="Image chdappff4" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appf.s2.3"><h5>People who avoided biopsy</h5><div id="chd.appf.fig5" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff5&p=BOOKS&id=576979_chdappff5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff5.jpg" alt="Image chdappff5" class="tileshop" title="Click on image to zoom" /></a></div></div><p>The forest plot shows the odds and not odds ratio – this was converted to the equivalent proportion for easy interpretation and this equates to 0.27 (0.22, 0.31)</p></div><div id="chd.appf.s2.4"><h5>Health related quality of life EQ 5D description</h5><div id="chd.appf.fig6" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff6&p=BOOKS&id=576979_chdappff6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff6.jpg" alt="Image chdappff6" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appf.s2.5"><h5>Investigator reported adverse events related to the interventions</h5><div id="chd.appf.fig7" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff7&p=BOOKS&id=576979_chdappff7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff7.jpg" alt="Image chdappff7" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="chd.appf.s2.6"><h5>Patient reported 30 day post intervention complications</h5><div id="chd.appf.fig8" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff8&p=BOOKS&id=576979_chdappff8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappff8.jpg" alt="Image chdappff8" class="tileshop" title="Click on image to zoom" /></a></div></div></div></div></div><div id="chd.appg"><h3>Appendix G. GRADE tables</h3><div id="chd.appg.s1"><h4>Diagnosing prostate cancer in people suspected to have prostate cancer (diagnostic cross-sectional studies)</h4><p id="chd.appg.tab1"><a href="/books/NBK576979/table/chd.appg.tab1/?report=objectonly" target="object" rid-ob="figobchdappgtab1" class="figpopup">Multiparametric MRI</a></p><p id="chd.appg.tab2"><a href="/books/NBK576979/table/chd.appg.tab2/?report=objectonly" target="object" rid-ob="figobchdappgtab2" class="figpopup">TRUS biopsy</a></p></div><div id="chd.appg.s2"><h4>Diagnosing prostate cancer – randomised control trials</h4><p id="chd.appg.tab3"><a href="/books/NBK576979/table/chd.appg.tab3/?report=objectonly" target="object" rid-ob="figobchdappgtab3" class="figpopup">MRI influenced prostate biopsy (Targeted biopsy) versus prostate biopsy</a></p></div></div><div id="chd.apph"><h3>Appendix H. Excluded studies</h3><div id="chd.apph.s1"><h4>Clinical studies</h4><div id="chd.apph.s1.1"><h5>RQ1 Diagnostic cross-sectional studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdapphtab1"><a href="/books/NBK576979/table/chd.apph.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdapphtab1" rid-ob="figobchdapphtab1"><img class="small-thumb" src="/books/NBK576979/table/chd.apph.tab1/?report=thumb" src-large="/books/NBK576979/table/chd.apph.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.apph.tab1"><a href="/books/NBK576979/table/chd.apph.tab1/?report=objectonly" target="object" rid-ob="figobchdapphtab1">Table</a></h4><p class="float-caption no_bottom_margin">Only included population with negative TRUS/MRI results Only included people with overall MRI score ≥3</p></div></div></div><div id="chd.apph.s1.2"><h5>Randomised control studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdapphtab2"><a href="/books/NBK576979/table/chd.apph.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdapphtab2" rid-ob="figobchdapphtab2"><img class="small-thumb" src="/books/NBK576979/table/chd.apph.tab2/?report=thumb" src-large="/books/NBK576979/table/chd.apph.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.apph.tab2"><a href="/books/NBK576979/table/chd.apph.tab2/?report=objectonly" target="object" rid-ob="figobchdapphtab2">Table</a></h4><p class="float-caption no_bottom_margin">Study does not contain any relevant interventions Not a randomised controlled trial</p></div></div></div></div><div id="chd.apph.s2"><h4>Economic studies</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdapphtab3"><a href="/books/NBK576979/table/chd.apph.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdapphtab3" rid-ob="figobchdapphtab3"><img class="small-thumb" src="/books/NBK576979/table/chd.apph.tab3/?report=thumb" src-large="/books/NBK576979/table/chd.apph.tab3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.apph.tab3"><a href="/books/NBK576979/table/chd.apph.tab3/?report=objectonly" target="object" rid-ob="figobchdapphtab3">Table</a></h4></div></div></div></div><div id="chd.appi"><h3>Appendix I. References</h3><div id="chd.appi.s1"><h4>Clinical studies - included - cross-sectional studies</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s1.ref1">Ahmed
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Hu, El-Shater Bosaily
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A, Brown
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Lc, Gabe
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R, Kaplan
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R, Parmar
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Mk, Collaco-Moraes
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Y, Ward
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K, Hindley
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Rg, Freeman
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A, Kirkham
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Ap, Oldroyd
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R, Parker
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C, and Emberton
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M (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet (no pagination), [<a href="https://pubmed.ncbi.nlm.nih.gov/28110982" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28110982</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s1.ref2">Nafie
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S, Mellon
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Jk, Dormer
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Jp, and Khan
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Ma (2014)The role of transperineal template prostate biopsies in prostate cancer diagnosis in biopsy naive men with PSA less than 20 ng ml-1. Prostate cancer and prostatic diseases
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17(2), 170–173 [<a href="https://pubmed.ncbi.nlm.nih.gov/24590360" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24590360</span></a>]</div></p></li></ul></div><div id="chd.appi.s2"><h4>Clinical studies - included - randomised control studies</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s2.ref1">Kasivisvanathan
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V, Rannikko
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AS, Borghi
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M, Panebianco
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V, Mynderse
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LA, Vaarala
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MH, Briganti
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A, Budaus
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L, Hellawell
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G, Hindley
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RG, Roobol
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MJ, Eggener
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S, Ghei
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M, Villers
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A, Bladou
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F, Villeirs
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GM, Virdi
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J, Boxler
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S, Robert
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G, Singh
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PB, Venderink
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W, Hadaschik
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BA, Ruffion
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A, Hu
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JC, Margolis
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D, Crouzet
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S, Klotz
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L, Taneja
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SS, Pinto
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P, Gill
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I, Allen
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C, Giganti
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F, Freeman
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A, Morris
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S, Punwani
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S, Williams
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NR, Brew-Graves
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C, Deeks
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J, Takwoingi
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Y, Emberton
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M, and Moore
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CM. (2018). MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis.. The New England journal of medicine, 378(19), pp.1767–1777. [<a href="/pmc/articles/PMC9084630/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9084630</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29552975" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29552975</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s2.ref2">Porpiglia
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F, Mele
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F, Manfredi
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M, Luca
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S, Checcucci
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E, Garrou
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D, Cattaneo
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G, Amparore
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D, Bollito
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E, Russo
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F, Gned
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D, Pascale
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A, Cirillo
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S, and Fiori
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C (2017) Standard prostate biopsy Versus MRI-fusion biopsy: results after two years of a prospective randomized study. Anticancer research. Conference: 27th annual meeting of the Italian society of uro-oncology, and siuro 2017. Italy
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37(4), 2148</div></p></li></ul></div><div id="chd.appi.s3"><h4>Clinical studies – excluded – cross-sectional studies</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref1">A’Amar
|
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O M, Liou
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L, Rodriguez-Diaz
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E, De Las Morenas, A, and Bigio
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I J (2013) Comparison of elastic scattering spectroscopy with histology in ex vivo prostate glands: Potential application for optically guided biopsy and directed treatment. Lasers in Medical Science
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28(5), 1323–1329 [<a href="https://pubmed.ncbi.nlm.nih.gov/23247663" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23247663</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref2">Abd-Alazeez
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Mohamed, Ahmed Hashim
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U, Arya
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Manit, Allen
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Clare, Dikaios
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Nikolaos, Freeman
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Alex, Emberton
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Mark, and Kirkham
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Alex (2014) Can multiparametric magnetic resonance imaging predict upgrading of transrectal ultrasound biopsy results at more definitive histology?. Urologic oncology
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32(6), 741–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/24981993" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24981993</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref3">Abd-Alazeez
|
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M, Kirkham
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A, Ahmed
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H U, Arya
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M, Anastasiadis
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E, Charman
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S C, Freeman
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A, and Emberton
|
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M (2014) Performance of multiparametric MRI in men at risk of prostate cancer before the first biopsy: A paired validating cohort study using template prostate mapping biopsies as the reference standard. Prostate Cancer and Prostatic Diseases
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17(1), 40–46 [<a href="/pmc/articles/PMC3954968/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3954968</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24126797" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24126797</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref4">Abd-Alazeez
|
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M, Ramachandran
|
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N, Dikaios
|
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N, Ahmed
|
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H U, Emberton
|
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M, Kirkham
|
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A, Arya
|
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M, Taylor
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S, Halligan
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S, and Punwani
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S (2015) Multiparametric MRI for detection of radiorecurrent prostate cancer: Added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images. Prostate Cancer and Prostatic Diseases
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18(2), 128–136 [<a href="https://pubmed.ncbi.nlm.nih.gov/25644248" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25644248</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref5">Abdi
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H, Pourmalek
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F, Zargar
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H, Walshe
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T, Harris
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A C, Chang
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S D, Eddy
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C, So
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A I, Gleave
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M E, Machan
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L, Goldenberg
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S L, and Black
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P C (2015) Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer. Urology
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85(2), 423–428 [<a href="https://pubmed.ncbi.nlm.nih.gov/25623709" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25623709</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref6">Abdollah
|
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F, Novara
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G, Briganti
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A, Scattoni
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V, Raber
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M, Roscigno
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M, Suardi
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N, Gallina
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A, Artibani
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W, Ficarra
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V, Cestari
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A, Guazzoni
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G, Rigatti
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P, and Montorsi
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F (2011) Trans-rectal versus trans-perineal saturation rebiopsy of the prostate: Is there a difference in cancer detection rate?. Urology
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77(4), 921–925 [<a href="https://pubmed.ncbi.nlm.nih.gov/21131034" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21131034</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref7">Abedi
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I, Tavakkoli
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M B, Rabbani
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Z, Schaefferkoetter
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J K, Kim
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Olivier, Henken Kirsten
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R, Somford Diederik
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N, Siegel
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M, Garcia
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P, Woo
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L M, Yao
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Js, Rosenkrantz
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Ab, Huang
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Wc, Stifelman
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I A, Ballard
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120(Supplement 3), 43–50 [<a href="https://pubmed.ncbi.nlm.nih.gov/28749035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28749035</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s3.ref180">Yoo
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Sangjun, Hong Jun
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C, Hiester
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C, Rabenalt
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M, Hiester
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Yong (2011) Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR. American journal of roentgenology
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197(5), W876–81 [<a href="https://pubmed.ncbi.nlm.nih.gov/22021535" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22021535</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref37">Porpiglia
|
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Francesco, Manfredi
|
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Matteo, Mele
|
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Fabrizio, Cossu
|
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Marco, Bollito
|
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Enrico, Veltri
|
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Andrea, Cirillo
|
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Stefano, Regge
|
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Daniele, Faletti
|
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Riccardo, Passera
|
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Roberto, Fiori
|
|
Cristian, De
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Luca, and Stefano (2017) Diagnostic Pathway with Multiparametric Magnetic Resonance Imaging Versus Standard Pathway: Results from a Randomized Prospective Study in Biopsy-naive Patients with Suspected Prostate Cancer. European urology
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72(2), 282–288 [<a href="https://pubmed.ncbi.nlm.nih.gov/27574821" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27574821</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref38">Porpiglia
|
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F, Mele
|
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F, Manfredi
|
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M, Luca
|
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S, Checcucci
|
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E, Bertolo
|
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R, Garrou
|
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D, Cattaneo
|
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G, Amparore
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D, Bollito
|
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E, Russo
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F, Gned
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D, Pascale
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A, Cirillo
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S, and Fiori
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C (2017) A prospective randomized study comparing standard prostate biopsy and a new diagnostic path with MRI and fusion biopsy: results after two years. European urology, supplements. Conference: 32nd annual european association of urology congress, and EAU 2017. United kingdom
|
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16(3), e869–e870</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref39">Sciarra
|
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A, Panebianco
|
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V, Cattarino
|
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S, Busetto
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Gm, Berardinis
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E, Ciccariello
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M, Gentile
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V, and Salciccia
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S (2012) Multiparametric magnetic resonance imaging of the prostate can improve the predictive value of the urinary prostate cancer antigen 3 test in patients with elevated prostate-specific antigen levels and a previous negative biopsy. BJU international
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110(11), 1661–1665 [<a href="https://pubmed.ncbi.nlm.nih.gov/22564540" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22564540</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref40">Shah Taimur
|
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Tariq, To Wilson King
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Lim, and Ahmed Hashim
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Uddin (2017) Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways. Expert review of anticancer therapy
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17(12), 1159–1168 [<a href="https://pubmed.ncbi.nlm.nih.gov/28933973" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28933973</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref41">Singh
|
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S, Dorairajan
|
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Ln, Manikandan
|
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R, Sreerag
|
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Ks, Sunil
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K, Kant
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Du, and Tepukiel
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Z (2017) Comparison of infective complications in transperineal versus transrectal ultrasound guided prostatic biopsy in patients suspected to have prostate cancer. Indian journal of urology. Conference: 50th annual conference of urological society of india, and USICON 2017. India
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33(Supplement 1) (no pagination),</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref42">Takenaka
|
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A, Hara
|
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R, Ishimura
|
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T, Fujii
|
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T, Jo
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Y, Nagai
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A, and Fujisawa
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M (2008) A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy. Prostate cancer and prostatic diseases
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11(2), 134–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/17533394" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17533394</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref43">Takuma
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K, Mikio
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S, Masashi
|
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I, Nobufumi
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U, Hiromi
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H, Yushi
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H, and Yoshiyuki
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K (2012) Transperineal ultrasound-guided multiple core biopsy using template for patients with one or more previous negative biopsies: comparison with systematic 10-core biopsy. Urology
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80(3 suppl. 1), S306–s307</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref44">Taverna
|
|
Gianluigi, Bozzini
|
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Giorgio, Grizzi
|
|
Fabio, Seveso
|
|
Mauro, Mandressi
|
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Alberto, Balzarini
|
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Luca, Mrakic
|
|
Federica, Bono
|
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Pietro, De Franceco, Oliviero, Buffi
|
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NicoloMaria, Lughezzani
|
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Giovanni, Lazzeri
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Massimo, Casale
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Paolo, and Guazzoni Giorgio
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Ferruccio (2016) Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial. World journal of urology
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34(6), 797–803 [<a href="https://pubmed.ncbi.nlm.nih.gov/26481226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26481226</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref45">Thompson
|
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J, Shnier
|
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R, Moses
|
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D, Brenner
|
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P, Delprado
|
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W, Tran
|
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M, Ponsky
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L, Boehm
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M, Hayen
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A, and Stricker
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P (2015) Prospective study of pre-biopsy multiparametric magnetic resonance imaging (MPMRI) compared to transperineal template mapping biopsy (TTMB) for detection of clinically significant prostate cancer: is it accurate enough to guide selection of men for biopsy?. Journal of urology. 193(4 suppl. 1), e959</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref46">Tonttila
|
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Pp, Lantto
|
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J, Pääkkö
|
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E, Piippo
|
|
U, Kauppila
|
|
S, Lammentausta
|
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E, Ohtonen
|
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P, and Vaarala
|
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Mh (2016) Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Diagnosis in Biopsy-naive Men with Suspected Prostate Cancer Based on Elevated Prostate-specific Antigen Values: results from a Randomized Prospective Blinded Controlled Trial. European urology
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69(3), 419–425 [<a href="https://pubmed.ncbi.nlm.nih.gov/26033153" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26033153</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref47">van Hove, A, Savoie
|
|
P H, Maurin
|
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C, Brunelle
|
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S, Gravis
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G, Salem
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N, and Walz
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J (2014) Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies. World journal of urology
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32(4), 847–858 [<a href="https://pubmed.ncbi.nlm.nih.gov/24919965" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24919965</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref48">Wegelin
|
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O, Melick
|
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H, Somford
|
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D, Bosch
|
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R, Kummer
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A, Vreuls
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W, and Barentsz
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J (2016) An interim analysis of the FUTURE trial; A RCT on three techniques of target prostate biopsy based on MR imaging. Comparison of detection rates of (significant) prostate cancer. European urology, and supplements. Conference: 8th european multidisciplinary meeting on urological cancers. Italy
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15(13), e1555–e1556</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref49">Winter
|
|
M, Garcia
|
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C, Bergersen
|
|
P, Woo
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H, and Chalasani
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V (2013) A systematic review with metaanalysis of transrectal prostate biopsy versus transperineal prostate biopsy for detecting prostate cancer. BJU international. 112, 22</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s4.ref50">Xie
|
|
L-P, Wang
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X, Zheng
|
|
X-Y, Liu
|
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B, Li
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J-F, and Wang
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S (2017) A randomized controlled trial to assess and compare the outcomes of AIUS-CT guided biopsy, transrectal ultrasound guided 12-core systematic biopsy, and mpMRI assisted 12-core systematic biopsy. European urology, supplements. Conference: 32nd annual european association of urology congress, and EAU 2017. United Kingdom
|
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16(3), e865–e866</div></p></li></ul></div><div id="chd.appi.s5"><h4>Economic studies – included</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s5.ref1">Faria
|
|
R, Soares
|
|
MO, Spackman
|
|
E, Ahmed
|
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HU, Brown
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LC, Kaplan
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R, Emberton
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M, Sculpher
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MJ. Optimising the diagnosis of prostate cancer in the era of multiparametric magnetic resonance imaging: a cost-effectiveness analysis based on the Prostate MR Imaging Study (PROMIS). European urology. 2018
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Jan
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1;73(1):23–30. [<a href="/pmc/articles/PMC5718727/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5718727</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28935163" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28935163</span></a>]</div></p></li></ul></div><div id="chd.appi.s6"><h4>Economic studies – excluded</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref1">Venderink
|
|
W, Govers
|
|
TM, de Rooij
|
|
M, Fütterer
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JJ, Sedelaar
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JM. Cost-effectiveness comparison of imaging-guided prostate biopsy techniques: systematic transrectal ultrasound, direct in-bore MRI, and image fusion. American Journal of Roentgenology. 2017
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May;208(5):1058–63. [<a href="https://pubmed.ncbi.nlm.nih.gov/28225639" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28225639</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref2">Willis
|
|
SR, van der Meulen
|
|
J, Valerio
|
|
M, Miners
|
|
A, Ahmed
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HU, Emberton
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M. A review of economic evaluations of diagnostic strategies using imaging in men at risk of prostate cancer. Current opinion in urology. 2015
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Nov
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1;25(6):483–9. [<a href="https://pubmed.ncbi.nlm.nih.gov/26372036" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26372036</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref3">Pahwa
|
|
S, Schiltz
|
|
NK, Ponsky
|
|
LE, Lu
|
|
Z, Griswold
|
|
MA, Gulani
|
|
V. Cost-effectiveness of MR imaging–guided strategies for detection of prostate cancer in biopsy-naive men. Radiology. 2017
|
|
May
|
|
17;285(1):157–66. [<a href="/pmc/articles/PMC5621719/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5621719</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28514203" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28514203</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref4">Loeb
|
|
S, Zhou
|
|
Q, Siebert
|
|
U, Rochau
|
|
U, Jahn
|
|
B, Mühlberger
|
|
N, Carter
|
|
HB, Lepor
|
|
H, Braithwaite
|
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RS. Active surveillance versus watchful waiting for localized prostate cancer: a model to inform decisions. European urology. 2017
|
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Dec
|
|
1;72(6):899–907. [<a href="/pmc/articles/PMC5694372/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5694372</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28844371" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28844371</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref5">Gordon
|
|
LG, James
|
|
R, Tuffaha
|
|
HW, Lowe
|
|
A, Yaxley
|
|
J. Cost‐effectiveness analysis of multiparametric MRI with increased active surveillance for low‐risk prostate cancer in Australia. Journal of Magnetic Resonance Imaging. 2017
|
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May
|
|
1;45(5):1304–15. [<a href="https://pubmed.ncbi.nlm.nih.gov/27726240" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27726240</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref6">de Rooij
|
|
M, Crienen
|
|
S, Witjes
|
|
JA, Barentsz
|
|
JO, Rovers
|
|
MM, Grutters
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|
JP. Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound–guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective. European urology. 2014
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Sep
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1;66(3):430–6. [<a href="https://pubmed.ncbi.nlm.nih.gov/24377803" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24377803</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref7">Cerantola
|
|
Y, Dragomir
|
|
A, Tanguay
|
|
S, Bladou
|
|
F, Aprikian
|
|
A, Kassouf
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W. Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. InUrologic Oncology: Seminars and Original Investigations
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2016
|
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Mar
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1 (Vol. 34, No. 3, pp. 119–e1). Elsevier. [<a href="https://pubmed.ncbi.nlm.nih.gov/26602178" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26602178</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref8">Mowatt
|
|
G, Scotland
|
|
G, Boachie
|
|
C, Cruickshank
|
|
M, Ford
|
|
JA, Fraser
|
|
C, Kurban
|
|
L, Lam
|
|
TB, Padhani
|
|
AR, Royle
|
|
J, Scheenen
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TW. The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health technology assessment. 2013. [<a href="/pmc/articles/PMC4781459/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4781459</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23697373" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23697373</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref9">Hövels
|
|
AM, Heesakkers
|
|
RA, Adang
|
|
EM, Barentsz
|
|
JO, Jager
|
|
GJ, Severens
|
|
JL. Cost-effectiveness of MR lymphography for the detection of lymph node metastases in patients with prostate cancer. Radiology. 2009
|
|
Sep;252(3):729–36. [<a href="https://pubmed.ncbi.nlm.nih.gov/19717752" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19717752</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref10">Roth
|
|
JA, Ramsey
|
|
SD, Carlson
|
|
JJ. Cost-effectiveness of a biopsy-based 8-protein prostate cancer prognostic assay to optimize treatment decision making in gleason 3+ 3 and 3+ 4 early stage prostate cancer. The oncologist. 2015
|
|
Dec
|
|
1;20(12):1355–64. [<a href="/pmc/articles/PMC4679086/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4679086</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26482553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26482553</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd.appi.s6.ref11">Nicholson
|
|
A, Mahon
|
|
J, Boland
|
|
A, Beale
|
|
S, Dwan
|
|
K, Fleeman
|
|
N, Hockenhull
|
|
J, Dundar
|
|
Y. The clinical effectiveness and cost-effectiveness of the PROGENSA (R) prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation. Health Technol Assess. 2015
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|
Oct
|
|
1;19(87):1–92. [<a href="/pmc/articles/PMC4780983/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4780983</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26507078" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26507078</span></a>]</div></p></li></ul></div></div><div id="chd.appj"><h3>Appendix J. Research Recommendations</h3><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappjtab1"><a href="/books/NBK576979/table/chd.appj.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappjtab1" rid-ob="figobchdappjtab1"><img class="small-thumb" src="/books/NBK576979/table/chd.appj.tab1/?report=thumb" src-large="/books/NBK576979/table/chd.appj.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appj.tab1"><a href="/books/NBK576979/table/chd.appj.tab1/?report=objectonly" target="object" rid-ob="figobchdappjtab1">Table</a></h4><p class="float-caption no_bottom_margin">Sensitivity Specificity</p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchdappjtab2"><a href="/books/NBK576979/table/chd.appj.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchdappjtab2" rid-ob="figobchdappjtab2"><img class="small-thumb" src="/books/NBK576979/table/chd.appj.tab2/?report=thumb" src-large="/books/NBK576979/table/chd.appj.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chd.appj.tab2"><a href="/books/NBK576979/table/chd.appj.tab2/?report=objectonly" target="object" rid-ob="figobchdappjtab2">Table</a></h4><p class="float-caption no_bottom_margin">Sensitivity Specificity</p></div></div></div><div id="chd.appk"><h3>Appendix K. PROMIS economic evaluation presentation</h3><div id="chd.appk.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf1&p=BOOKS&id=576979_chdappkf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf1.jpg" alt="Image chdappkf1" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig2" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf2&p=BOOKS&id=576979_chdappkf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf2.jpg" alt="Image chdappkf2" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig3" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf3&p=BOOKS&id=576979_chdappkf3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf3.jpg" alt="Image chdappkf3" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig4" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf4&p=BOOKS&id=576979_chdappkf4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf4.jpg" alt="Image chdappkf4" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig5" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf5&p=BOOKS&id=576979_chdappkf5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf5.jpg" alt="Image chdappkf5" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig6" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf6&p=BOOKS&id=576979_chdappkf6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf6.jpg" alt="Image chdappkf6" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig7" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf7&p=BOOKS&id=576979_chdappkf7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf7.jpg" alt="Image chdappkf7" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig8" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf8&p=BOOKS&id=576979_chdappkf8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf8.jpg" alt="Image chdappkf8" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig9" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf9&p=BOOKS&id=576979_chdappkf9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf9.jpg" alt="Image chdappkf9" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig10" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf10&p=BOOKS&id=576979_chdappkf10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf10.jpg" alt="Image chdappkf10" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig11" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf11&p=BOOKS&id=576979_chdappkf11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf11.jpg" alt="Image chdappkf11" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig12" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf12&p=BOOKS&id=576979_chdappkf12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf12.jpg" alt="Image chdappkf12" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig13" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf13&p=BOOKS&id=576979_chdappkf13.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf13.jpg" alt="Image chdappkf13" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig14" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf14&p=BOOKS&id=576979_chdappkf14.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf14.jpg" alt="Image chdappkf14" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig15" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf15&p=BOOKS&id=576979_chdappkf15.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf15.jpg" alt="Image chdappkf15" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig16" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf16&p=BOOKS&id=576979_chdappkf16.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf16.jpg" alt="Image chdappkf16" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig17" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf17&p=BOOKS&id=576979_chdappkf17.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf17.jpg" alt="Image chdappkf17" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig18" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf18&p=BOOKS&id=576979_chdappkf18.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf18.jpg" alt="Image chdappkf18" class="tileshop" title="Click on image to zoom" 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/></a></div></div><div id="chd.appk.fig21" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf21&p=BOOKS&id=576979_chdappkf21.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf21.jpg" alt="Image chdappkf21" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig22" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf22&p=BOOKS&id=576979_chdappkf22.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf22.jpg" alt="Image chdappkf22" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig23" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf23&p=BOOKS&id=576979_chdappkf23.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf23.jpg" alt="Image chdappkf23" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig24" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf24&p=BOOKS&id=576979_chdappkf24.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf24.jpg" alt="Image chdappkf24" class="tileshop" title="Click on image to zoom" 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/></a></div></div><div id="chd.appk.fig57" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf57&p=BOOKS&id=576979_chdappkf57.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf57.jpg" alt="Image chdappkf57" class="tileshop" title="Click on image to zoom" /></a></div></div><div id="chd.appk.fig58" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappkf58&p=BOOKS&id=576979_chdappkf58.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK576979/bin/chdappkf58.jpg" alt="Image chdappkf58" class="tileshop" title="Click on image to zoom" /></a></div></div></div></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Evidence review</p><p>developed by the NICE Guideline Updates Team</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK576979</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35099860" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35099860</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobchdtab1"><div id="chd.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO table –Diagnostic test accuracy studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_chd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>People with suspected prostate cancer</div></li></ul></td></tr><tr><th id="hd_b_chd.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index tests</th><td headers="hd_b_chd.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Multiparametric MRI</div></li><li class="half_rhythm"><div>Multiparametric MRI targeted biopsy</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic or standard)</div><div><i>TRUS biopsy also referred to as saturation or extended biopsy</i></div></li></ul></td></tr><tr><th id="hd_b_chd.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><td headers="hd_b_chd.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Transperineal template biopsy</div></li></ul></td></tr><tr><th id="hd_b_chd.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_chd.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Diagnostic yield</div></li><li class="half_rhythm"><div>Diagnostic accuracy
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<ul class="circle"><li class="half_rhythm"><div>Sensitivity and specificity</div></li><li class="half_rhythm"><div>Likelihood ratios</div></li></ul></div><div><i>If available from studies reporting diagnostic accuracy we will also extract information on:</i></div></li><li class="half_rhythm"><div>Number of Adverse events
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<ul class="circle"><li class="half_rhythm"><div>Haemorrhage</div></li><li class="half_rhythm"><div>Sepsis</div></li><li class="half_rhythm"><div>Failure to diagnose</div></li><li class="half_rhythm"><div>Pain</div></li><li class="half_rhythm"><div>Sexual dysfunction</div></li><li class="half_rhythm"><div>Urine retention</div></li><li class="half_rhythm"><div>Hospitalisation</div></li><li class="half_rhythm"><div>Prostatitis</div></li></ul></div></li><li class="half_rhythm"><div>Missed cancers</div></li><li class="half_rhythm"><div>Health-related quality of life -</div></li><li class="half_rhythm"><div>If reported – psychological aspects of quality of life to be reported separately</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdtab2"><div id="chd.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">PICO table –Randomised control studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.tab2_lrgtbl__"><table><tbody><tr><th id="hd_b_chd.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chd.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>People with suspected prostate cancer</div></li></ul></td></tr><tr><th id="hd_b_chd.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_chd.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Multiparametric MRI</div></li><li class="half_rhythm"><div>Multiparametric MRI targeted biopsy</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic or standard)</div><div><i>TRUS biopsy also referred to as saturation or extended biopsy</i></div></li></ul></td></tr><tr><th id="hd_b_chd.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Control</th><td headers="hd_b_chd.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Multiparametric/biparametric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic or standard</div><div><i>TRUS biopsy also referred to as saturation or extended biopsy</i></div></li></ul></td></tr><tr><th id="hd_b_chd.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_chd.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Proportion of men with clinically significant cancer (as defined by the studies)</div></li><li class="half_rhythm"><div>Proportion of men who go on to definitive local or systemic treatment</div></li><li class="half_rhythm"><div>Proportion of men with clinically insignificant cancer detected</div></li><li class="half_rhythm"><div>Proportion of men who avoided biopsy</div></li><li class="half_rhythm"><div>Proportion or Number of Adverse events</div></li><li class="half_rhythm"><div>Haemorrhage</div></li><li class="half_rhythm"><div>Sepsis</div></li><li class="half_rhythm"><div>Failure to diagnose</div></li><li class="half_rhythm"><div>Pain</div></li><li class="half_rhythm"><div>Sexual dysfunction</div></li><li class="half_rhythm"><div>Urine retention</div></li><li class="half_rhythm"><div>Hospitalisation</div></li><li class="half_rhythm"><div>Prostatitis</div></li><li class="half_rhythm"><div>Missed cancers</div></li><li class="half_rhythm"><div>Health-related quality of life - for example:</div></li><li class="half_rhythm"><div>European Organisation for Research and Treatment of Cancer quality of life,</div></li><li class="half_rhythm"><div>EPIC instrument</div></li><li class="half_rhythm"><div>If reported – psychological aspects of quality of life to be reported separately</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdtab3"><div id="chd.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of studies for diagnosing prostate cancer in people suspected to have prostate cancer (cross-sectional studies)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chd.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study (year)</th><th id="hd_h_chd.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_chd.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Prior biopsy</th><th id="hd_h_chd.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index test</th><th id="hd_h_chd.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference Standard</th><th id="hd_h_chd.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Unit of Analysis</th><th id="hd_h_chd.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MRI Criteria for Biopsy<sup>1</sup></th><th id="hd_h_chd.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Significant disease definition</th></tr></thead><tbody><tr><td headers="hd_h_chd.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Ahmed (2017)</p>
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<p>UK</p>
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</td><td headers="hd_h_chd.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">576</td><td headers="hd_h_chd.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_chd.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ol><li class="half_rhythm"><div>MP-MRI comprising of 1.5 T magnetic field strength. T1-weighted, T2-weighted, diffusion weighted and dynamic gadolinium contrast-enhanced imaging sequences were acquired</div></li><li class="half_rhythm"><div>TRUS biopsy</div></li></ol></td><td headers="hd_h_chd.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal template prostate mapping biopsy</td><td headers="hd_h_chd.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patient</td><td headers="hd_h_chd.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>5 Likert scale Score ≥ 3</p>
|
|
<p>(1, very low level of suspicion; 2, low level of suspicion; 3, equivocal; 4, cancer probable; 5, definitely cancer).</p>
|
|
</td><td headers="hd_h_chd.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ol><li class="half_rhythm"><div>UCL definition 1: Gleason ≥4+3 and/or maximum cancer core length (CCLmax) ≥6mm</div></li><li class="half_rhythm"><div>UCL definition 2: Gleason ≥3+4 and/or CCLmax ≥4mm</div></li></ol></td></tr><tr><td headers="hd_h_chd.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Nafie (2014)</p>
|
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<p>UK</p>
|
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</td><td headers="hd_h_chd.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_chd.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_chd.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TRUS Biopsy – 12 TRUS guided core biopsies were taken with 6 each from the right and left peripheral zones</td><td headers="hd_h_chd.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic template prostate mapping biopsy using brachytherapy grid under general anaesthesia.</td><td headers="hd_h_chd.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patient</td><td headers="hd_h_chd.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_chd.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ol><li class="half_rhythm"><div>Any cancer</div></li></ol></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdtab4"><div id="chd.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Summary of studies for diagnosing prostate cancer in people suspected to have prostate cancer (randomised control studies)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_chd.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study (year)</th><th id="hd_h_chd.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">N</th><th id="hd_h_chd.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Prior biopsy</th><th id="hd_h_chd.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Intervention Group</th><th id="hd_h_chd.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Control Group</th><th id="hd_h_chd.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Inclusion criteria</th><th id="hd_h_chd.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Disease definition</th></tr></thead><tbody><tr><td headers="hd_h_chd.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Kasivisnathan (2018)</p>
|
|
<p>(UK)</p>
|
|
</td><td headers="hd_h_chd.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">500</td><td headers="hd_h_chd.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_chd.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MRI and MRI targeted biopsy</td><td headers="hd_h_chd.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Standard TRUS biopsy</p>
|
|
<p>
|
|
<i>A total of 10-12 biopsy cores were obtained from the peripheral zone</i>
|
|
</p>
|
|
</td><td headers="hd_h_chd.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">PSA level of 20ng/ml or less</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Abnormal DRE and not suggestive of extracapsular disease</p></dd></dl></dl></td><td headers="hd_h_chd.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Clinically significant</b>
|
|
</p>
|
|
<p>Disease of Gleason score 3+4 (Gleason sum of 7) or greater</p>
|
|
<p>
|
|
<b>Clinically insignificant</b>
|
|
</p>
|
|
|
|
<ul><li class="half_rhythm"><div>Gleason score 3+3</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_chd.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Porpiglia (2017)</p>
|
|
<p>(Italy)</p>
|
|
</td><td headers="hd_h_chd.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">212</td><td headers="hd_h_chd.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_chd.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MRI and MRI targeted biopsy</p>
|
|
<p><i>Biopsies were performed via either transrectal or transperineal approach based on the location of the region of interest</i>.</p>
|
|
</td><td headers="hd_h_chd.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Standard TRUS biopsy</p>
|
|
<p>
|
|
<i>12 biopsy cores were obtained</i>
|
|
</p>
|
|
</td><td headers="hd_h_chd.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">prostate-specific antigen (PSA) level ≤15ng/ml</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">negative digital rectal examination results</p></dd></dl></dl></td><td headers="hd_h_chd.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Clinically significant</b>
|
|
<ul><li class="half_rhythm"><div>MCCL ≥5mm or Gleason ≥ 7 disease</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappatab1"><div id="chd.appa.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">ID</th><th id="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field (based on <a href="http://www.prisma-statement.org/Extensions/Protocols.aspx" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PRISMA-P</a>)</th><th id="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">I</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Which of the following, alone or in combination, constitutes the most clinical and cost- effective pathway for diagnosing prostate cancer:
|
|
<ul><li class="half_rhythm"><div>Multiparametric or biparametric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic)</div></li><li class="half_rhythm"><div>Transperineal template biopsy</div></li></ul>
|
|
<i>TRUS biopsy also referred to as saturation or extended biopsy</i></td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">II</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">III</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>To assess whether undertaking MRI prior to biopsy increases diagnostic yield and to determine which of the following, alone or in combination, constitutes the most clinical and cost-effective pathway for diagnosing prostate cancer:
|
|
<ul><li class="half_rhythm"><div>Multiparametric or biparametric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic)</div></li></ul>
|
|
Transperineal template biopsy</p>
|
|
<p><i>This question was identified as requiring updating during the 2016 exceptional surveillance review. Recommendations may be made on where MRI should feature in the diagnostic pathway</i>.</p>
|
|
</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IV</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with suspected prostate cancer</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">V</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index Tests</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>Multiparametric or biparametric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy,)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic or standard)</div></li></ul>
|
|
<ul><li class="half_rhythm"><div><i>TRUS biopsy also referred to as saturation or extended biopsy</i></div></li></ul></td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VI</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference (gold) standard</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>Transperineal template biopsy</div></li></ul>
|
|
(<i>also referred to as mapping)</i></td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Diagnostic yield</p>
|
|
<p>Diagnostic accuracy
|
|
<ul><li class="half_rhythm"><div>Sensitivity and specificity</div></li><li class="half_rhythm"><div>Likelihood ratios</div></li></ul>
|
|
<i>If available from studies reporting diagnostic accuracy we will also extract information on</i>:
|
|
<ul><li class="half_rhythm"><div>Number of Adverse events
|
|
<ul class="circle"><li class="half_rhythm"><div>Haemorrhage</div></li><li class="half_rhythm"><div>Sepsis</div></li><li class="half_rhythm"><div>Failure to diagnose</div></li><li class="half_rhythm"><div>Pain</div></li><li class="half_rhythm"><div>Sexual dysfunction</div></li><li class="half_rhythm"><div>Urine retention</div></li><li class="half_rhythm"><div>Hospitalisation</div></li><li class="half_rhythm"><div>Prostatitis</div></li><li class="half_rhythm"><div>Missed cancers</div></li></ul></div></li><li class="half_rhythm"><div>Health-related quality of life - for example:
|
|
<ul class="circle"><li class="half_rhythm"><div>European Organisation for Research and Treatment of Cancer quality of life,</div></li><li class="half_rhythm"><div>EPIC instrument</div></li></ul></div></li></ul>
|
|
<i>If reported – <u>psychological aspects</u> of quality of life to be reported separately</i></p>
|
|
</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VIII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Diagnostic cross-sectional studies</div></li><li class="half_rhythm"><div>Systematic reviews of diagnostic cross-sectional studies</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IX</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other exclusion criteria</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Non English- language papers will be excluded</div></li><li class="half_rhythm"><div>Case-control studies</div></li><li class="half_rhythm"><div>Retrospective studies</div></li><li class="half_rhythm"><div>Screening studies</div></li><li class="half_rhythm"><div>Studies in people with an established diagnosis of prostate cancer at the time of diagnostic assessments</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">X</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity/sub-group analysis, or meta-regression</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None identified</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XI</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening/selecti on/analysis</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10% of the abstracts will be reviewed by two reviewers, with any disagreements resolved by discussion or, if necessary, a third independent reviewer. If meaningful disagreements are found between the different reviewers, a further 10% of the abstracts will be reviewed by two reviewers, with this process continued until agreement is achieved between the two reviewers. From this point, the remaining abstracts will be screened by a single reviewer.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> – section 1.3</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XIII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appc">appendix C</a> of the relevant chapter</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIV</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Update of 2014 prostate cancer guideline question:</p>
|
|
<p>Does multiparametric/functional MRI before TRUS biopsy increase diagnostic yield of initial biopsy in men with suspected prostate cancer?</p>
|
|
<p>Since the question is substantially different, a new review protocol has been developed.</p>
|
|
<p>
|
|
<b>List of recommendations that may be affected</b>
|
|
</p>
|
|
<p>1.2.6 Consider multiparametric MRI (using T2- and diffusion-weighted imaging) for men with a negative transrectal ultrasound 10–12 core biopsy to determine whether another biopsy is needed. <b>[new 2014]</b></p>
|
|
<p>1.2.7 Do not offer another biopsy if the multiparametric MRI (using T2- and diffusion-weighted imaging) is negative, unless any of the risk factors listed in recommendation 1.2.5 are present. <b>[new 2014]</b></p>
|
|
<p>1.2.8 Determine the provisional treatment intent (radical or non-radical) before decisions on imaging are made. <b>[2008]</b></p>
|
|
<p>1.2.9 Do not routinely offer imaging to men who are not candidates for radical treatment. <b>[2008]</b></p>
|
|
<p>1.2.11 Consider multiparametric MRI, or CT if MRI is contraindicated, for men with histologically proven prostate</p>
|
|
<p>cancer if knowledge of the T or N stage could affect management. <b>[new 2014]</b></p>
|
|
</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XV</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guideline updates team, National Institute for Health and Care Excellence (contact <a href="mailto:dev@null" data-email="ku.gro.ecin@efeeko.mada" class="oemail">ku.gro.ecin@efeeko.mada</a>)</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XVI</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This is not an amendment to a previous protocol.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XVII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#chd.appc">appendix C</a> of relevant chapter. Searches run from 2007 on advice from the guideline committee.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XVIII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms/duplicate</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#chd.appe">appendix E</a> (clinical evidence tables) or <a href="#chd.apph">H</a> (economic evidence tables). 10% of data will be extracted by 2 reviewers, with any disagreements resolved by discussion or, if necessary, a third independent reviewer. If meaningful disagreements are found between the different reviewers, a further 10% of the data will be extracted by 2 reviewers, with this process continued until agreement is achieved between the 2 reviewers.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XIX</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#chd.appe">appendix E</a> (clinical evidence tables) or <a href="#chd.apph">H</a> (economic evidence tables). Further detail on NICE evidence tables is available in section <a href="https://www.nice.org.uk/process/pmg20/chapter/reviewing-research-evidence#presenting-and-summarising-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">6.4 of Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XX</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome/study level</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below – see section 1.6</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXI</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis (where suitable)</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below – see section 1.6.2</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXIII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below – see section 1.6.3 and 1.6.5</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXIV</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment of confidence in cumulative evidence</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below - see section 1.6.3</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXV</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale/context – Current management</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review in the main file.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXVI</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A multidisciplinary committee will develop the guideline update. The committee was convened by the NICE Guideline Updates Team and chaired by Waqaar Shah in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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<p>Staff from NICE will undertake systematic literature searches, appraise the evidence, conduct meta-analyses and cost-effectiveness analyses where appropriate, and draft the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXVII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding/support</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NICE Guideline Updates Team is an internal team within NICE.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXVIII</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NICE Guideline Updates Team is an internal team within NICE.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXIX</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NICE Guideline Updates Team is an internal team within NICE.</td></tr><tr><td headers="hd_h_chd.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXX</td><td headers="hd_h_chd.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_chd.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappatab2"><div id="chd.appa.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">ID</th><th id="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field (based on <a href="http://www.prisma-statement.org/Extensions/Protocols.aspx" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PRISMA-P</a>)</th><th id="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">I</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Which of the following, alone or in combination, constitutes the most clinical and cost- effective pathway for diagnosing prostate cancer:
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<ul><li class="half_rhythm"><div>Multiparametric or biparametric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic)</div></li><li class="half_rhythm"><div>Transperineal template biopsy</div></li></ul>
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<i>TRUS biopsy also referred to as saturation or extended biopsy</i></td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">II</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">III</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>To determine which of the following, alone or in combination, constitutes the most clinical and cost- effective pathway for diagnosing prostate cancer:
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<ul><li class="half_rhythm"><div>Multiparametric or biparametric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic)</div></li></ul>
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Transperineal template biopsy</p>
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<p><i>This question was identified as requiring updating during the 2016 exceptional surveillance review. Recommendations may be made on where MRI should feature in the diagnostic pathway</i>.</p>
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</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IV</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with suspected prostate cancer</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">V</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – intervention(s)/ex posure(s)/progno stic factor(s)</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>Multiparametric/biparamteric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy,)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic or standard)</div></li></ul>
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<i>TRUS biopsy also referred to as saturation or extended biopsy</i></td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VI</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – comparator(s)/co ntrol or reference (gold) standard</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>Multiparametric/biparamteric MRI alone</div></li><li class="half_rhythm"><div>MRI influenced TRUS biopsy (MRI-targeted and MRI-guided TRUS biopsy,)</div></li><li class="half_rhythm"><div>TRUS biopsy alone (systematic or standard</div></li></ul>
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<i>TRUS biopsy also referred to as saturation or extended biopsy</i></td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>Proportion of men with clinically significant cancer (as defined by the studies)</div></li><li class="half_rhythm"><div>Proportion of men who go on to definitive local or systemic treatment</div></li><li class="half_rhythm"><div>Proportion of men with clinically insignificant cancer detected</div></li><li class="half_rhythm"><div>Proportion of men who avoided biopsy</div></li><li class="half_rhythm"><div>Proportion or Number of Adverse events
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<ul class="circle"><li class="half_rhythm"><div>Haemorrhage</div></li><li class="half_rhythm"><div>Sepsis</div></li><li class="half_rhythm"><div>Failure to diagnose</div></li><li class="half_rhythm"><div>Pain</div></li><li class="half_rhythm"><div>Sexual dysfunction</div></li><li class="half_rhythm"><div>Urine retention</div></li><li class="half_rhythm"><div>Hospitalisation</div></li><li class="half_rhythm"><div>Prostatitis</div></li><li class="half_rhythm"><div>Missed cancers</div></li></ul></div></li><li class="half_rhythm"><div>Health-related quality of life - for example:
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<ul class="circle"><li class="half_rhythm"><div>European Organisation for Research and Treatment of Cancer quality of life,</div></li><li class="half_rhythm"><div>EPIC instrument</div></li></ul></div></li></ul>
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<i>If reported – <u>psychological aspects</u> of quality of life to be reported separately</i></td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VIII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Randomised control trials</div></li><li class="half_rhythm"><div>Systematic reviews of randomised control trials</div></li></ul>
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</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IX</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other exclusion criteria</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Non English- language papers will be excluded</div></li><li class="half_rhythm"><div>Case-control studies</div></li><li class="half_rhythm"><div>Retrospective studies</div></li><li class="half_rhythm"><div>Screening studies</div></li><li class="half_rhythm"><div>Studies in people with an established diagnosis of prostate cancer at the time of diagnostic assessments</div></li></ul>
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</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">X</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity/sub-group analysis, or meta-regression</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Different definitions of significant cancers</div></li><li class="half_rhythm"><div>Follow -up times</div></li></ul>
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</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XI</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening/selecti on/analysis</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10% of the abstracts will be reviewed by two reviewers, with any disagreements resolved by discussion or, if necessary, a third independent reviewer. If meaningful disagreements are found between the different reviewers, a further 10% of the abstracts will be reviewed by two reviewers, with this process continued until agreement is achieved between the two reviewers. From this point, the remaining abstracts will be screened by a single reviewer.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> – section 1.3</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XIII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appc">appendix C</a> of the relevant chapter</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIV</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Update of 2014 prostate cancer guideline question:</p>
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<p>Does multiparametric/functional MRI before TRUS biopsy increase diagnostic yield of initial biopsy in men with suspected prostate cancer?</p>
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<p>Since the question is substantially different, a new review protocol has been developed.</p>
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<p>
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<b>List of recommendations that may be affected</b>
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</p>
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<p>1.2.6 Consider multiparametric MRI (using T2- and diffusion-weighted imaging) for men with a negative transrectal ultrasound 10–12 core biopsy to determine whether another biopsy is needed. <b>[new 2014]</b></p>
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<p>1.2.7 Do not offer another biopsy if the multiparametric MRI (using T2- and diffusion-weighted imaging) is negative, unless any of the risk factors listed in recommendation 1.2.5 are present. <b>[new 2014]</b></p>
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<p>1.2.8 Determine the provisional treatment intent (radical or non-radical) before decisions on imaging are made. <b>[2008]</b></p>
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<p>1.2.9 Do not routinely offer imaging to men who are not candidates for radical treatment. <b>[2008]</b></p>
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<p>1.2.11 Consider multiparametric MRI, or CT if MRI is contraindicated, for men with histologically proven prostate cancer if knowledge of the T or N stage could affect management. <b>[new 2014]</b></p>
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</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XV</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guideline updates team, National Institute for Health and Care Excellence (contact <a href="mailto:dev@null" data-email="ku.gro.ecin@efeeko.mada" class="oemail">ku.gro.ecin@efeeko.mada</a>)</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XVI</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This is not an amendment to a previous protocol.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XVII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#chd.appc">appendix C</a> of relevant chapter. Searches run from 2007 on advice from the guideline committee.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XVIII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms/duplicate</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#chd.appe">appendix E</a> (clinical evidence tables) or <a href="#chd.apph">H</a> (economic evidence tables). 10% of data will be extracted by 2 reviewers, with any disagreements resolved by discussion or, if necessary, a third independent reviewer. If meaningful disagreements are found between the different reviewers, a further 10% of the data will be extracted by 2 reviewers, with this process continued until agreement is achieved between the 2 reviewers.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XIX</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#chd.appe">appendix E</a> (clinical evidence tables) or <a href="#chd.apph">H</a> (economic evidence tables). Further detail on NICE evidence tables is available in section <a href="https://www.nice.org.uk/process/pmg20/chapter/reviewing-research-evidence#presenting-and-summarising-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">6.4 of Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XX</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome/study level</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below – see section 1.6</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXI</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis (where suitable)</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below – see section 1.6.2</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXIII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below – see section 1.6.3 and 1.6.5</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXIV</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment of confidence in cumulative evidence</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See <a href="#chd.appb">Appendix B</a> below - see section 1.6.3</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXV</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale/context – Current management</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review in the main file.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXVI</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A multidisciplinary committee will develop the guideline update. The committee was convened by the NICE Guideline Updates Team and chaired by Waqaar Shah in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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<p>Staff from NICE will undertake systematic literature searches, appraise the evidence, conduct meta-analyses and cost-effectiveness analyses where appropriate, and draft the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXVII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding/support</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NICE Guideline Updates Team is an internal team within NICE.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXVIII</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NICE Guideline Updates Team is an internal team within NICE.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXIX</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NICE Guideline Updates Team is an internal team within NICE.</td></tr><tr><td headers="hd_h_chd.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">XXX</td><td headers="hd_h_chd.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_chd.appa.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappbtab1"><div id="chd.appb.tab1" class="table"><h3><span class="label">Table 5</span><span class="title">Rationale for downgrading quality of evidence for intervention studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE criteria</th><th id="hd_h_chd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reasons for downgrading quality</th></tr></thead><tbody><tr><td headers="hd_h_chd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</td><td headers="hd_h_chd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from studies at high risk of bias, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies at high and low risk of bias.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</td><td headers="hd_h_chd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from indirect studies, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between direct and indirect studies.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</td><td headers="hd_h_chd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Concerns about inconsistency of effects across studies, occurring when there is unexplained variability in the treatment effect demonstrated across studies (heterogeneity), after appropriate pre-specified subgroup analyses have been conducted. This was assessed using the I<sup>2</sup> statistic.</p>
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<p>N/A: Inconsistency was marked as not applicable if data on the outcome was only available from one study.</p>
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<p>Not serious: If the I<sup>2</sup> was less than 33.3%, the outcome was not downgraded.</p>
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<p>Serious: If the I<sup>2</sup> was between 33.3% and 66.7%, the outcome was downgraded one level.</p>
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<p>Very serious: If the I<sup>2</sup> was greater than 66.7%, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies with the smallest and largest effect sizes.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</td><td headers="hd_h_chd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>If an MID other than the line of no effect was defined for the outcome, the outcome was downgraded once if the 95% confidence interval for the effect size crossed one line of the MID, and twice if it crosses both lines of the MID.</p>
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<p>If the line of no effect was defined as an MID for the outcome, it was downgraded once if the 95% confidence interval for the effect size crossed the line of no effect (i.e. the outcome was not statistically significant), and twice if the sample size of the study was sufficiently small that it is not plausible any realistic effect size could have been detected.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if the confidence interval was sufficiently narrow that the upper and lower bounds would correspond to clinically equivalent scenarios.</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappbtab2"><div id="chd.appb.tab2" class="table"><h3><span class="label">Table 6</span><span class="title">Interpretation of likelihood ratios</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of likelihood ratio</th><th id="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interpretation</th></tr></thead><tbody><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LR ≤ 0.1</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Very large</b> decrease in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.1 < LR ≤ 0.2</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Large</b> decrease in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.2 < LR ≤ 0.5</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Moderate</b> decrease in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.5 < LR ≤ 1.0</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Slight</b> decrease in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.0 < LR < 2.0</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Slight</b> increase in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.0 ≤ LR < 5.0</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Moderate</b> increase in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.0 ≤ LR < 10.0</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Large</b> increase in probability of disease</td></tr><tr><td headers="hd_h_chd.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LR ≥ 10.0</td><td headers="hd_h_chd.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Very large</b> increase in probability of disease</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappbtab3"><div id="chd.appb.tab3" class="table"><h3><span class="label">Table 7</span><span class="title">Rationale for downgrading quality of evidence for diagnostic questions</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE criteria</th><th id="hd_h_chd.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reasons for downgrading quality</th></tr></thead><tbody><tr><td headers="hd_h_chd.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</td><td headers="hd_h_chd.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from studies at high risk of bias, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies at high and low risk of bias.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</td><td headers="hd_h_chd.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from indirect studies, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between direct and indirect studies.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</td><td headers="hd_h_chd.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Concerns about inconsistency of effects across studies, occurring when there is unexplained variability in the treatment effect demonstrated across studies (heterogeneity), after appropriate pre-specified subgroup analyses have been conducted. This was assessed using the I<sup>2</sup> statistic.</p>
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<p>N/A: Inconsistency was marked as not applicable if data on the outcome was only available from one study.</p>
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<p>Not serious: If the I<sup>2</sup> was less than 33.3%, the outcome was not downgraded.</p>
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<p>Serious: If the I<sup>2</sup> was between 33.3% and 66.7%, the outcome was downgraded one level.</p>
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<p>Very serious: If the I<sup>2</sup> was greater than 66.7%, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies with the smallest and largest effect sizes.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</td><td headers="hd_h_chd.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>If the 95% confidence interval for a positive likelihood ratio spanned 2, the outcome was downgraded one level, as the data were deemed to be consistent with a meaningful increase in risk and no meaningful predictive value. Similarly, negative likelihood ratios that spanned 0.5 led to downgrading for serious imprecision. Any likelihood ratios that spanned both 0.5 and 2 were downgraded twice, as suffering from very serious imprecision.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if the confidence interval was sufficiently narrow that the upper and lower bounds would correspond to clinically equivalent scenarios.</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappbtab4"><div id="chd.appb.tab4" class="table"><h3><span class="label">Table 8</span><span class="title">Interpretation of kappa coefficient</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appb.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Value of kappa coefficients</th><th id="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation</th></tr></thead><tbody><tr><td headers="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">k < 0</td><td headers="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No agreement</td></tr><tr><td headers="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 < k ≤ 0.2</td><td headers="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Poor agreement</td></tr><tr><td headers="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.2 < k ≤ 0.4</td><td headers="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fair agreement</td></tr><tr><td headers="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4 < k ≤ 0.7</td><td headers="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Good agreement</td></tr><tr><td headers="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.7 < k ≤ 1.0</td><td headers="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excellent agreement</td></tr><tr><td headers="hd_h_chd.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">k = 1.0</td><td headers="hd_h_chd.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complete agreement</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappbtab5"><div id="chd.appb.tab5" class="table"><h3><span class="label">Table 9</span><span class="title">Rationale for downgrading evidence for inter-rater agreement</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE criteria</th><th id="hd_h_chd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reasons for downgrading quality</th></tr></thead><tbody><tr><td headers="hd_h_chd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</td><td headers="hd_h_chd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from studies at high risk of bias, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies at high and low risk of bias.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</td><td headers="hd_h_chd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from indirect studies, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between direct and indirect studies.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</td><td headers="hd_h_chd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Concerns about inconsistency of effects across studies, occurring when there is unexplained variability in the treatment effect demonstrated across studies (heterogeneity), after appropriate pre-specified subgroup analyses have been conducted. This was assessed using the I<sup>2</sup> statistic.</p>
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<p>N/A: Inconsistency was marked as not applicable if data on the outcome was only available from one study.</p>
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<p>Not serious: If the I<sup>2</sup> was less than 33.3%, the outcome was not downgraded.</p>
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<p>Serious: If the I<sup>2</sup> was between 33.3% and 66.7%, the outcome was downgraded one level.</p>
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<p>Very serious: If the I<sup>2</sup> was greater than 66.7%, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies with the smallest and largest effect sizes.</p>
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</td></tr><tr><td headers="hd_h_chd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</td><td headers="hd_h_chd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>If the 95% confidence interval for the kappa coefficient spanned two of the categories in <a class="figpopup" href="/books/NBK576979/table/chd.appb.tab4/?report=objectonly" target="object" rid-figpopup="figchdappbtab4" rid-ob="figobchdappbtab4">Table 8</a>, it was downgraded one level. If the 95% confidence interval for the kappa coefficient spanned three or more of the categories in <a class="figpopup" href="/books/NBK576979/table/chd.appb.tab4/?report=objectonly" target="object" rid-figpopup="figchdappbtab4" rid-ob="figobchdappbtab4">Table 8</a>, it was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if the confidence interval was sufficiently narrow that the upper and lower bounds would correspond to clinically equivalent scenarios.</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappctab1"><div id="chd.appc.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appc.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appc.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database: Ovid MEDLINE(R) </th></tr></thead><tbody><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 exp Prostatic Neoplasms/</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 Prostatic Intraepithelial Neoplasia/</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 (prostat* adj4 (neoplas* or cancer* or carcinoma* or adenocarcinom* or tumour* or tumor* or malignan* or metasta* or angiosarcoma* or sarcoma* or teratoma* or lymphoma* or blastoma* or microcytic* or carcino* or leiomyosarcoma* or lump*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 PIN.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 or/1-4</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 *Magnetic Resonance Imaging/</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 (magnet* adj2 (resonance* or imag* or scan* or spectroscop*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 (MR adj2 (resonance* or imag* or scan* or spectroscop*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 (Dynamic contrast* enhanc* adj2 (MR* or magnet*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 (contrast* adj2 (imag* or scan*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 ((MRI or MRSI or MP-MR* or MPMR*) adj4 prostat*).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 turbo spin echo*.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 ((diffusion* or weight*) adj2 imag*).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 ((DWI or DCE-MRI or T2W or TSE or T2-weighted MRI*) adj4 prostat*).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 (Multi-parametric or multiparametric* or biparametric* or bi-parametric*).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 *biopsy/ or *image-guided biopsy/</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 ((transrectal* or trans-rectal* or transperineal* or trans-perineal*) adj2 (ultrasound* or biops*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 ((saturat* or extend* or templat*) adj2 (ultrasound* or biops*)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 ((TRUS or TRUSB) adj4 prostat*).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 or/6-19</td></tr><tr><td headers="hd_h_chd.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 5 and 20</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappctab2"><div id="chd.appc.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appc.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appc.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The MEDLINE diagnostic filter</th></tr></thead><tbody><tr><td headers="hd_h_chd.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 (sensitiv: or diagnos:).mp. or di.fs.</td></tr><tr><td headers="hd_h_chd.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 Prostate/dg or Prostatic Neoplasms/dg</td></tr><tr><td headers="hd_h_chd.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 or/1-3</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappctab3"><div id="chd.appc.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appc.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appc.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The MEDLINE economic evaluations and quality of life search filters are presented below. They were translated for use in the MEDLINE In-Process and Embase databases.</th></tr></thead><tbody><tr><th headers="hd_h_chd.appc.tab3_1_1_1_1" id="hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economic evaluations</th></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 Economics/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 exp “Costs and Cost Analysis”/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 Economics, Dental/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 exp Economics, Hospital/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 exp Economics, Medical/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 Economics, Nursing/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 Economics, Pharmaceutical/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 Budgets/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 exp Models, Economic/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 Markov Chains/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 Monte Carlo Method/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 Decision Trees/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 econom$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 cba.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 cea.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 cua.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 markov$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 (monte adj carlo).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 (decision adj3 (tree$ or analys$)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 (cost or costs or costing$ or costly or costed).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 (price$ or pricing$).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 budget$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 expenditure$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 (value adj3 (money or monetary)).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 (pharmacoeconomic$ or (pharmaco adj economic$)).tw. 26 or/1-25</td></tr><tr><th headers="hd_h_chd.appc.tab3_1_1_1_1" id="hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life</th></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 “Quality of Life”/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 quality of life.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 “Value of Life”/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 Quality-Adjusted Life Years/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 quality adjusted life.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 (qaly$ or qald$ or qale$ or qtime$).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 disability adjusted life.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 daly$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 Health Status Indicators/</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 (sf36 or sf 36 or short form 36 or shortform 36 or sf thirtysix or sf thirty six or shortform thirtysix or shortform thirty six or short form thirtysix or short form thirty six).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 (sf6 or sf 6 or short form 6 or shortform 6 or sf six or sfsix or shortform six or short form six).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 (sf12 or sf 12 or short form 12 or shortform 12 or sf twelve or sftwelve or shortform twelve or short form twelve).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 (sf16 or sf 16 or short form 16 or shortform 16 or sf sixteen or sfsixteen or shortform sixteen or short form sixteen).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 (sf20 or sf 20 or short form 20 or shortform 20 or sf twenty or sftwenty or shortform twenty or short form twenty).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 (euroqol or euro qol or eq5d or eq 5d).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 (qol or hql or hqol or hrqol).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 (hye or hyes).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 health$ year$ equivalent$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 utilit$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 (hui or hui1 or hui2 or hui3).tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 disutili$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 rosser.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 quality of wellbeing.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 quality of well-being.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 qwb.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 willingness to pay.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 standard gamble$.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 time trade off.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29 time tradeoff.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30 tto.tw.</td></tr><tr><td headers="hd_h_chd.appc.tab3_1_1_1_1 hd_b_chd.appc.tab3_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 or/1-30</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobchdappdfig1"><div id="chd.appd.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappdf1&p=BOOKS&id=576979_chdappdf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappdf1.jpg" alt="Image chdappdf1" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappdfig2"><div id="chd.appd.fig2" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappdf2&p=BOOKS&id=576979_chdappdf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappdf2.jpg" alt="Image chdappdf2" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappdfig3"><div id="chd.appd.fig3" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappdf3&p=BOOKS&id=576979_chdappdf3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappdf3.jpg" alt="Image chdappdf3" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig1"><div id="chd.appf.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff1&p=BOOKS&id=576979_chdappff1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff1.jpg" alt="Image chdappff1" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig2"><div id="chd.appf.fig2" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff2&p=BOOKS&id=576979_chdappff2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff2.jpg" alt="Image chdappff2" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig3"><div id="chd.appf.fig3" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff3&p=BOOKS&id=576979_chdappff3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff3.jpg" alt="Image chdappff3" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig4"><div id="chd.appf.fig4" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff4&p=BOOKS&id=576979_chdappff4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff4.jpg" alt="Image chdappff4" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig5"><div id="chd.appf.fig5" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff5&p=BOOKS&id=576979_chdappff5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff5.jpg" alt="Image chdappff5" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig6"><div id="chd.appf.fig6" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff6&p=BOOKS&id=576979_chdappff6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff6.jpg" alt="Image chdappff6" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig7"><div id="chd.appf.fig7" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff7&p=BOOKS&id=576979_chdappff7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff7.jpg" alt="Image chdappff7" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="fig" id="figobchdappffig8"><div id="chd.appf.fig8" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20chdappff8&p=BOOKS&id=576979_chdappff8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576979/bin/chdappff8.jpg" alt="Image chdappff8" class="tileshop" title="Click on image to zoom" /></a></div></div></article><article data-type="table-wrap" id="figobchdappgtab1"><div id="chd.appg.tab1" class="table"><h3><span class="title">Multiparametric MRI</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appg.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appg.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_chd.appg.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_chd.appg.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_chd.appg.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity (95% CI)</th><th id="hd_h_chd.appg.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity (95% CI)</th><th id="hd_h_chd.appg.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_chd.appg.tab1_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_chd.appg.tab1_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_chd.appg.tab1_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_chd.appg.tab1_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_chd.appg.tab1_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chd.appg.tab1_1_1_1_1 hd_h_chd.appg.tab1_1_1_1_2 hd_h_chd.appg.tab1_1_1_1_3 hd_h_chd.appg.tab1_1_1_1_4 hd_h_chd.appg.tab1_1_1_1_5 hd_h_chd.appg.tab1_1_1_1_6 hd_h_chd.appg.tab1_1_1_1_7 hd_h_chd.appg.tab1_1_1_1_8 hd_h_chd.appg.tab1_1_1_1_9 hd_h_chd.appg.tab1_1_1_1_10 hd_h_chd.appg.tab1_1_1_1_11" id="hd_b_chd.appg.tab1_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI - (reference standard: transperineal template mapping biopsy) analysis by person, MRI threshold ≥2</th></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_1 hd_b_chd.appg.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1 study</p>
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<p>Ahmed (2017)</p>
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|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_2 hd_b_chd.appg.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Prospective cross sectional study</td><td headers="hd_h_chd.appg.tab1_1_1_1_3 hd_b_chd.appg.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">576</td><td headers="hd_h_chd.appg.tab1_1_1_1_4 hd_b_chd.appg.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.98 (0.96, 0.99)</td><td headers="hd_h_chd.appg.tab1_1_1_1_5 hd_b_chd.appg.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.07 (0.05, 0.11)</td><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>LR- 0.26</p>
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<p>(0.11, 0.65)</p>
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</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>LR+ 1.06</p>
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<p>(1.02, 1.10)</p>
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</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab1_1_1_1_1 hd_h_chd.appg.tab1_1_1_1_2 hd_h_chd.appg.tab1_1_1_1_3 hd_h_chd.appg.tab1_1_1_1_4 hd_h_chd.appg.tab1_1_1_1_5 hd_h_chd.appg.tab1_1_1_1_6 hd_h_chd.appg.tab1_1_1_1_7 hd_h_chd.appg.tab1_1_1_1_8 hd_h_chd.appg.tab1_1_1_1_9 hd_h_chd.appg.tab1_1_1_1_10 hd_h_chd.appg.tab1_1_1_1_11" id="hd_b_chd.appg.tab1_1_1_4_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI - (reference standard: transperineal template mapping biopsy) analysis by person, MRI threshold ≥3</th></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_1 hd_b_chd.appg.tab1_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1 study</p>
|
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<p>Ahmed (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_2 hd_b_chd.appg.tab1_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Prospective cross sectional study</td><td headers="hd_h_chd.appg.tab1_1_1_1_3 hd_b_chd.appg.tab1_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">576</td><td headers="hd_h_chd.appg.tab1_1_1_1_4 hd_b_chd.appg.tab1_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.93 (0.88, 0.95)</td><td headers="hd_h_chd.appg.tab1_1_1_1_5 hd_b_chd.appg.tab1_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.41 (0.36, 0.46)</td><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR- 0.18</p>
|
|
<p>(0.11, 0.29)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR+ 1.56</p>
|
|
<p>(1.42, 1.72)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab1_1_1_1_1 hd_h_chd.appg.tab1_1_1_1_2 hd_h_chd.appg.tab1_1_1_1_3 hd_h_chd.appg.tab1_1_1_1_4 hd_h_chd.appg.tab1_1_1_1_5 hd_h_chd.appg.tab1_1_1_1_6 hd_h_chd.appg.tab1_1_1_1_7 hd_h_chd.appg.tab1_1_1_1_8 hd_h_chd.appg.tab1_1_1_1_9 hd_h_chd.appg.tab1_1_1_1_10 hd_h_chd.appg.tab1_1_1_1_11" id="hd_b_chd.appg.tab1_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI - (reference standard: transperineal template mapping biopsy) analysis by person, MRI threshold ≥4</th></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_1 hd_b_chd.appg.tab1_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Ahmed (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_2 hd_b_chd.appg.tab1_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Prospective cross sectional study</td><td headers="hd_h_chd.appg.tab1_1_1_1_3 hd_b_chd.appg.tab1_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">576</td><td headers="hd_h_chd.appg.tab1_1_1_1_4 hd_b_chd.appg.tab1_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.68 (0.62, 0.73)</td><td headers="hd_h_chd.appg.tab1_1_1_1_5 hd_b_chd.appg.tab1_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.86 (0.81, 0.89)</td><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR- 0.38</p>
|
|
<p>(0.32, 0.45)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR+ 4.70</p>
|
|
<p>(3.44, 6.42)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab1_1_1_1_1 hd_h_chd.appg.tab1_1_1_1_2 hd_h_chd.appg.tab1_1_1_1_3 hd_h_chd.appg.tab1_1_1_1_4 hd_h_chd.appg.tab1_1_1_1_5 hd_h_chd.appg.tab1_1_1_1_6 hd_h_chd.appg.tab1_1_1_1_7 hd_h_chd.appg.tab1_1_1_1_8 hd_h_chd.appg.tab1_1_1_1_9 hd_h_chd.appg.tab1_1_1_1_10 hd_h_chd.appg.tab1_1_1_1_11" id="hd_b_chd.appg.tab1_1_1_10_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI - (reference standard: transperineal template mapping biopsy) analysis by person, MRI threshold of 5</th></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_1 hd_b_chd.appg.tab1_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Ahmed (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_2 hd_b_chd.appg.tab1_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Prospective cross-sectional study</td><td headers="hd_h_chd.appg.tab1_1_1_1_3 hd_b_chd.appg.tab1_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">576</td><td headers="hd_h_chd.appg.tab1_1_1_1_4 hd_b_chd.appg.tab1_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.40 (0.35, 0.52)</td><td headers="hd_h_chd.appg.tab1_1_1_1_5 hd_b_chd.appg.tab1_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.97 (0.94, 0.99)</td><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR- 0.62</p>
|
|
<p>(0.57, 0.68)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_chd.appg.tab1_1_1_1_6 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR+ 14.25</p>
|
|
<p>(6.78, 29.95)</p>
|
|
</td><td headers="hd_h_chd.appg.tab1_1_1_1_7 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_8 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab1_1_1_1_9 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_10 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not Serious</td><td headers="hd_h_chd.appg.tab1_1_1_1_11 hd_b_chd.appg.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappgtab2"><div id="chd.appg.tab2" class="table"><h3><span class="title">TRUS biopsy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appg.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appg.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_chd.appg.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_chd.appg.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_chd.appg.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity (95% CI)</th><th id="hd_h_chd.appg.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity (95% CI)</th><th id="hd_h_chd.appg.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_chd.appg.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_chd.appg.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_chd.appg.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_chd.appg.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_chd.appg.tab2_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chd.appg.tab2_1_1_1_1 hd_h_chd.appg.tab2_1_1_1_2 hd_h_chd.appg.tab2_1_1_1_3 hd_h_chd.appg.tab2_1_1_1_4 hd_h_chd.appg.tab2_1_1_1_5 hd_h_chd.appg.tab2_1_1_1_6 hd_h_chd.appg.tab2_1_1_1_7 hd_h_chd.appg.tab2_1_1_1_8 hd_h_chd.appg.tab2_1_1_1_9 hd_h_chd.appg.tab2_1_1_1_10 hd_h_chd.appg.tab2_1_1_1_11" id="hd_b_chd.appg.tab2_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">TRUS biopsy - (reference standard: transperineal template mapping biopsy) analysis by person</th></tr><tr><td headers="hd_h_chd.appg.tab2_1_1_1_1 hd_b_chd.appg.tab2_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2 studies</p>
|
|
<p>Ahmed (2017)</p>
|
|
<p>Nafie (2014)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_2 hd_b_chd.appg.tab2_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Prospective cross sectional study</td><td headers="hd_h_chd.appg.tab2_1_1_1_3 hd_b_chd.appg.tab2_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">626</td><td headers="hd_h_chd.appg.tab2_1_1_1_4 hd_b_chd.appg.tab2_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.49 (0.43, 0.55)</td><td headers="hd_h_chd.appg.tab2_1_1_1_5 hd_b_chd.appg.tab2_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.96 (0.94, 0.98)</td><td headers="hd_h_chd.appg.tab2_1_1_1_6 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR- 0.53</p>
|
|
<p>(0.47, 0.82)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_7 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_8 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_9 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_10 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_chd.appg.tab2_1_1_1_11 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_chd.appg.tab2_1_1_1_6 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR+ 13.12</p>
|
|
<p>(7.65, 22.50)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_7 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_8 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_9 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_10 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_11 hd_b_chd.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab2_1_1_1_1 hd_h_chd.appg.tab2_1_1_1_2 hd_h_chd.appg.tab2_1_1_1_3 hd_h_chd.appg.tab2_1_1_1_4 hd_h_chd.appg.tab2_1_1_1_5 hd_h_chd.appg.tab2_1_1_1_6 hd_h_chd.appg.tab2_1_1_1_7 hd_h_chd.appg.tab2_1_1_1_8 hd_h_chd.appg.tab2_1_1_1_9 hd_h_chd.appg.tab2_1_1_1_10 hd_h_chd.appg.tab2_1_1_1_11" id="hd_b_chd.appg.tab2_1_1_4_1" colspan="11" rowspan="1" style="text-align:center;vertical-align:top;">Definition of clinically significant cancer - UCL definition 1: Gleason ≥4+3 and/or maximum cancer core length (CCLmax) ≥6mm</th></tr><tr><td headers="hd_h_chd.appg.tab2_1_1_1_1 hd_b_chd.appg.tab2_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Ahmed (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_2 hd_b_chd.appg.tab2_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Cross sectional study</td><td headers="hd_h_chd.appg.tab2_1_1_1_3 hd_b_chd.appg.tab2_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">576</td><td headers="hd_h_chd.appg.tab2_1_1_1_4 hd_b_chd.appg.tab2_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.44 (0.30, 0.59)</td><td headers="hd_h_chd.appg.tab2_1_1_1_5 hd_b_chd.appg.tab2_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.96 (0.94, 0.98</td><td headers="hd_h_chd.appg.tab2_1_1_1_6 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR- 0.54</p>
|
|
<p>(0.47, 0.61)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_7 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_8 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab2_1_1_1_9 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_10 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_chd.appg.tab2_1_1_1_11 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_chd.appg.tab2_1_1_1_6 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR+ 12.84</p>
|
|
<p>(7.41, 22.26)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_7 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_8 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab2_1_1_1_9 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_10 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_11 hd_b_chd.appg.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab2_1_1_1_1 hd_h_chd.appg.tab2_1_1_1_2 hd_h_chd.appg.tab2_1_1_1_3 hd_h_chd.appg.tab2_1_1_1_4 hd_h_chd.appg.tab2_1_1_1_5 hd_h_chd.appg.tab2_1_1_1_6 hd_h_chd.appg.tab2_1_1_1_7 hd_h_chd.appg.tab2_1_1_1_8 hd_h_chd.appg.tab2_1_1_1_9 hd_h_chd.appg.tab2_1_1_1_10 hd_h_chd.appg.tab2_1_1_1_11" id="hd_b_chd.appg.tab2_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Definition of clinically significant cancer - Any cancer</th></tr><tr><td headers="hd_h_chd.appg.tab2_1_1_1_1 hd_b_chd.appg.tab2_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1 study</p>
|
|
<p>Nafie (2014)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_2 hd_b_chd.appg.tab2_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Cross sectional study</td><td headers="hd_h_chd.appg.tab2_1_1_1_3 hd_b_chd.appg.tab2_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_chd.appg.tab2_1_1_1_4 hd_b_chd.appg.tab2_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.53 (0.36, 0.70)</td><td headers="hd_h_chd.appg.tab2_1_1_1_5 hd_b_chd.appg.tab2_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">0.98 (0.71, 1.00)</td><td headers="hd_h_chd.appg.tab2_1_1_1_6 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR- 0.60</p>
|
|
<p>(0.44, 0.82)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_7 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab2_1_1_1_8 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab2_1_1_1_9 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_10 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_11 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><td headers="hd_h_chd.appg.tab2_1_1_1_6 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LR+ 12.34</p>
|
|
<p>(7.32, 20.80)</p>
|
|
</td><td headers="hd_h_chd.appg.tab2_1_1_1_7 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab2_1_1_1_8 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab2_1_1_1_9 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_10 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab2_1_1_1_11 hd_b_chd.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chd.appg.tab2_1"><p class="no_margin">95% confidence interval for likelihood ratio crosses one end of a defined MID interval – (0.5, 2), downgraded once</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chd.appg.tab2_2"><p class="no_margin">Moderate risk of bias – due to selection bias – unclear how the study participants were selected, downgraded once</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchdappgtab3"><div id="chd.appg.tab3" class="table"><h3><span class="title">MRI influenced prostate biopsy (Targeted biopsy) versus prostate biopsy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appg.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appg.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No. of studies</th><th id="hd_h_chd.appg.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><th id="hd_h_chd.appg.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sample size</th><th id="hd_h_chd.appg.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect size (95% CI)</th><th id="hd_h_chd.appg.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Absolute risk: control</th><th id="hd_h_chd.appg.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Absolute risk: intervention (95% CI)</th><th id="hd_h_chd.appg.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_chd.appg.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</th><th id="hd_h_chd.appg.tab3_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</th><th id="hd_h_chd.appg.tab3_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</th><th id="hd_h_chd.appg.tab3_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Proportion of people with clinically significant cancer (RR>1 favours MRI group)</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>2 Studies</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
<p>Porpligia (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">712</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.79 (1.12, 2.87)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>23.5 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>42.1 per</p>
|
|
<p>100 people (26.3 Fewer to 67.4 more)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>1</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Proportion of people with clinically insignificant cancer (RR>1 favours MRI group)</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2 Studies</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
<p>Porpligia (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">712</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.39 (0.25, 0.59)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>18.9 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.4 per 100 people (4.73 fewer to 11.2 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not Serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Proportion of people who avoided biopsy</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2 studies</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
<p>Porpligia (2017)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">456</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.27 (0.22, 0.31)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Health-related quality of life measured by EQ-5D (descriptive score) (MD >0 favours MRI group)</th></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_7_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_8_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Score at 24 hours post intervention</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">500</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 0.01 (−0.01. 0.04)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_7_1 hd_b_chd.appg.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_10_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Score at 30 days post intervention</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">500</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 0.00 (−0.03. 0.02)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_12_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Investigator reported adverse event related to the interventions (RR<1 favours MRI group)</th></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_12_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_13_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Sepsis</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">500</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.25 (0.03, 2.19)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1.61 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.3 per 100 people (4.27 fewer to 32.5 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>3</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_12_1 hd_b_chd.appg.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_15_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Haematuria</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">500</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.39 (0.01, 8.01)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4 per 100 people</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.16 per 100 people (0.004 fewer to 3.2 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_17_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Prostatitis</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">500</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 6.89 (0.36, 132.86)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No cases in the control group</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unable to calculate</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>3</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_19_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Patient reported adverse event related to the interventions (RR<1 favours MRI group)</th></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_19_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_20_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Fever</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.97 (0.39, 2.40)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.37 per 100 people</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.24 per 100 people (1.70 fewer to 23.8 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>3</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_19_1 hd_b_chd.appg.tab3_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_22_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Blood in the urine</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.48 (0.38, 0.61)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>62.6 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.1 per 100 people (23.8 fewer to 38.2 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_24_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Blood in the semen</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvan athan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.54 (0.43, 0.67)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>59.7 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.2 per 100 people (25.7 fewer to 40.0 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_26_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Blood in the stools or back passage</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.65 (0.43, 0.99)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>21.8 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.2 per 100 people (9.39 fewer to 21.6 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_26_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_28_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Acute urinary retention</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.46 (0.25, 8.63)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>0.97 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.42 per 100 people (0.24 fewer to 8.34 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>3</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_30_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Erectile dysfunction</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.70 (0.42, 1.15)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>15.5 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.9 per 100 people (6.52 fewer to 17.9 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_30_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_32_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Urinary incontinence</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.26 (0.57, 2.82)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>4.85 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.12 per 100 people (2.77 fewer to 13.7 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>3</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_32_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_34_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Urinary tract infection</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 2.43 (0.48, 12.38)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>0.97 per</p>
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|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.36 per 100 people (0.47 fewer to 12.0 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup>3</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_36_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Pain at site of procedure</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.55 (0.36, 0.84)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>23.3 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.8 per 100 people (8.39 fewer to 19.6 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_36_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_chd.appg.tab3_1_1_1_1 hd_h_chd.appg.tab3_1_1_1_2 hd_h_chd.appg.tab3_1_1_1_3 hd_h_chd.appg.tab3_1_1_1_4 hd_h_chd.appg.tab3_1_1_1_5 hd_h_chd.appg.tab3_1_1_1_6 hd_h_chd.appg.tab3_1_1_1_7 hd_h_chd.appg.tab3_1_1_1_8 hd_h_chd.appg.tab3_1_1_1_9 hd_h_chd.appg.tab3_1_1_1_10 hd_h_chd.appg.tab3_1_1_1_11" id="hd_b_chd.appg.tab3_1_1_38_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:top;">Men for whom another procedure would be a major problem</th></tr><tr><td headers="hd_h_chd.appg.tab3_1_1_1_1 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 study</p>
|
|
<p>Kasivisvanathan (2018)</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_2 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td><td headers="hd_h_chd.appg.tab3_1_1_1_3 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">418</td><td headers="hd_h_chd.appg.tab3_1_1_1_4 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.19 (0.04, 0.88)</td><td headers="hd_h_chd.appg.tab3_1_1_1_5 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>4.85 per</p>
|
|
<p>100 people</p>
|
|
</td><td headers="hd_h_chd.appg.tab3_1_1_1_6 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.92 per 100 people (0.19 fewer to 4.27 more)</td><td headers="hd_h_chd.appg.tab3_1_1_1_7 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_8 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td><td headers="hd_h_chd.appg.tab3_1_1_1_9 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_chd.appg.tab3_1_1_1_10 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chd.appg.tab3_1_1_1_11 hd_b_chd.appg.tab3_1_1_38_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chd.appg.tab3_1"><p class="no_margin">I<sup>2</sup> was greater than 66.7%, downgraded twice</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chd.appg.tab3_2"><p class="no_margin">the 95% confidence interval for the effect size crossed one line of the MID, downgraded once</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chd.appg.tab3_3"><p class="no_margin">the 95% confidence interval for the effect size crossed both lines of the MIDs, downgraded twice</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchdapphtab1"><div id="chd.apph.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Short Title</th><th id="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Title</th><th id="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A’Amar (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of elastic scattering spectroscopy with histology in ex vivo prostate glands: Potential application for optically guided biopsy and directed treatment</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abd-Alazeez (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Performance of multiparametric MRI in men at risk of prostate cancer before the first biopsy: A paired validating cohort study using template prostate mapping biopsies as the reference standard</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Only included population with negative TRUS/MRI results</p>
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<p>Only included people with overall MRI score ≥3</p>
|
|
</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abd-Alazeez (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can multiparametric magnetic resonance imaging predict upgrading of transrectal ultrasound biopsy results at more definitive histology?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abd-Alazeez (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI for detection of radiorecurrent prostate cancer: Added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study population have high risk prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abdi (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abdollah (2011)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trans-rectal versus trans-perineal saturation rebiopsy of the prostate: Is there a difference in cancer detection rate?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abedi (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric magnetic resonance imaging of prostate cancer: Association of quantitative magnetic resonance parameters with histopathologic findings</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abouassaly (2008)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Staging Saturation Biopsy in Patients with Prostate Cancer on Active Surveillance Protocol</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abu (2011)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The use of MRI scanning to triage patients</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acar (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI guidance in first-time prostate biopsies: What is the real benefit?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">An (2018)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ruling out clinically significant prostate cancer with negative multi-parametric MRI</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anastasiadis (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What Burden of Prostate Cancer Can Radiologists Rule Out on Multiparametric Magnetic Resonance Imaging? A Sensitivity Analysis Based on Varying the Target Condition in Template Prostate Mapping Biopsies</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arumainaya gam (2010)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Accuracy of multiparametric magnetic resonance imaging in detecting recurrent prostate cancer after radiotherapy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people with suspected/low risk/intermediate prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Barrett (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Targeted transperineal biopsy of the prostate has limited additional benefit over background cores for larger MRI-identified tumors</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Barrett (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The emerging role of MRI in prostate cancer active surveillance and ongoing challenges</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Barzell (2007)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Appropriate Patient Selection in the Focal Treatment of Prostate Cancer: The Role of Transperineal 3-Dimensional Pathologic Mapping of the Prostate-A 4-Year Experience</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Becker (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Direct comparison of PI-RADS version 2 and version 1 regarding interreader agreement and diagnostic accuracy for the detection of clinically significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bittner (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incidence and pathological features of prostate cancer detected on transperineal template guided mapping biopsy after negative transrectal ultrasound guided biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Only included population with negative TRUS/MRI results</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bjurlin (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bladou (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Boesen (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Early experience with multiparametric magnetic resonance imaging-targeted biopsies under visual transrectal ultrasound guidance in patients suspicious for prostate cancer undergoing repeated biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Borkowetz (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment of tumour aggressiveness in tranperineal mri/ultrasound-fusion biopsy in comparison to transrectal systematic prostate biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Borkowetz (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound-fusion biopsy for the diagnosis of prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bosco (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confirmatory biopsy for the assessment of prostate cancer in men considering active surveillance: Reference centre experience</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brock (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Detecting Prostate Cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Not a relevant study design (cross-sectional study)</p>
|
|
<p>The study was of a case/control design</p>
|
|
</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brown (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROMIS - Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Duplicate reference</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Castellucci (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance spectroscopic imaging 3T and prostate cancer: correlation with transperineal ultrasound guided prostate biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol TRUS biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chen (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3-tesla magnetic resonance imaging improves the prostate cancer detection rate in transrectral ultrasound-guided biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol Systematic biopsy/TRUS biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chen (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Men with no suspicious lesions were excluded from the study and reference standard was robotic transperineal template biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cool (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Di Franco (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a relevant study design (crosssectional study) and Full text screening (diagnostic) and Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dieffenbacher (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy of transperineal MRI fusion biopsy in comparison to transrectal biopsy with regard to incidental histopathological findings in transurethral resection of the prostate</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dikaios (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Logistic regression model for diagnosis of transition zone prostate cancer on multi-parametric MRI</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dikaios (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zone-specific logistic regression models improve classification of prostate cancer on multi-parametric MRI</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Duplicate reference</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Donaldson (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The smarttarget biopsy trial: a prospective paired blinded trial with randomisation to compare visual-estimation and image-fusion targeted prostate biopsies</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Durand (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance microscopy may enable distinction between normal histomorphological features and prostate cancer in the resected prostate gland</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elkhoury (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Targeted Prostate Biopsy in the Era of Active Surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elkjaer (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multi-parametric magnetic resonance imaging and magnetic resonance guided biopsies at active surveillance inclusion selects prostate cancer patients for active treatment</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Duplicate reference</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">El-Shater (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROMIS-Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Protocol article</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Faiella (2018)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analysis of histological findings obtained combining US/mp-MRI fusion-guided biopsies with systematic US biopsies: mp-MRI role in prostate cancer detection and false negative</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Felker (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">In-bore magnetic resonance-guided transrectal biopsy for the detection of clinically significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ferriero (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic performance of multiparametric MRI in prostate cancer: per core analysis of two prospective ultrasound/MRI fusion biopsy datasets</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fusco (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A systematic review on multiparametric MR imaging in prostate cancer detection</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review- not clear what the reference standard was for this systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Futterer (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All relevant studies were included in the review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Garcia (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal versus transrectal prostate biopsy in prostate cancer detection: a systematic review with meta-analysis</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Garcia (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does transperineal prostate biopsy reduce complications compared with transrectal biopsy? A systematic review and metaanalysis of randomised controlled trials</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Garcia (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evaluation of MR imaging-targeted biopsies of the prostate in biopsy-naive patients. A single centre study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol Systematic Biopsy/Trus guided transperineal biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gayet (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy platforms in prostate cancer detection: A systematic review</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol (Systematic review)</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gaziev (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusion-guided transperineal prostate biopsies as a validation tool</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Investigating user technique</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gnanapragasam (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gomez-Iturriaga (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal biopsies of MRI-detected aggressive index lesions in low- and intermediate-risk prostate cancer patients: Implications for treatment decision</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gordetsky (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Perineural Invasion in Prostate Cancer Is More Frequently Detected by Multiparametric MRI Targeted Biopsy Compared With Standard Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Grey (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Grummet (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">How to Biopsy: Transperineal Versus Transrectal, Saturation Versus Targeted, What’s the Evidence?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Habchi (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of prostate multiparametric magnetic resonance imaging for predicting biopsy results in first or repeat biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Habibian (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imaging Characteristics of Prostate Cancer Patients Who Discontinued Active Surveillance on 3-T Multiparametric Prostate MRI</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hakozaki (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective study of magnetic resonance imaging and ultrasonography (MRI/US)-fusion targeted biopsy and concurrent systematic transperineal biopsy with the average of 18-cores to detect clinically significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol Combined reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hamoen (2018)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of Serial Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Imaging-guided Biopsies in Men with Low-risk Prostate Cancer on Active Surveillance After 1 Yr Follow-up</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hansen (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance and Ultrasound Image Fusion Supported Transperineal Prostate Biopsy Using the Ginsburg Protocol: Technique, Learning Points, and Biopsy Results</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Combined reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hansen (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric Prostate Magnetic Resonance Imaging and Cognitively Targeted Transperineal Biopsy in Patients With Previous Abdominoperineal Resection and Suspicion of Prostate Cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hansen (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hansford (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dynamic contrast-enhanced MR imaging features of the normal central zone of the prostate</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hausmann (2018)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prostate cancer detection among readers with different degree of experience using ultra-high b-value diffusion-weighted Imaging: Is a non-contrast protocol sufficient to detect significant cancer?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hauth (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI of the prostate with three functional techniques in patients with PSA elevation before initial TRUS-guided biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hu (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A biopsy simulation study to assess the accuracy of several transrectal ultrasonography (TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ishioka (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computer-aided diagnosis of prostate cancer using a deep neural networks algorithm in prebiopsy multiparametric magnetic resonance imaging</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jambor (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prebiopsy multiparametric 3T prostate MRI in patients with elevated PSA, normal digital rectal examination, and no previous biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jiang (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging - Ultrasound fusion targeted biopsy outperforms standard approaches in detecting prostate cancer: A meta-analysis</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jones (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Optimizing safety and accuracy of prostate biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jue (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kamoi (2008)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Utility of Transrectal Real-Time Elastography in the Diagnosis of Prostate Cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kanoun (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18F-Choline Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging for the Detection of Early Local Recurrence of Prostate Cancer Initially Treated by Radiation Therapy: comparison With Systematic 3-Dimensional Transperineal Mapping Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study population have high risk prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kanthabalan (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Biopsy strategies for selecting patients for focal therapy for prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kanthabalan (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal Magnetic Resonance Imaging-targeted Biopsy versus Transperineal Template Prostate Mapping Biopsy in the Detection of Localised Radio-recurrent Prostate Cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Men with no suspicious lesions were excluded from the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kapoor (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Re: Diagnostic Accuracy of Multi-parametric MRI and TRUS Biopsy in Prostate Cancer (PROMIS): A Paired Validating Confirmatory Study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kasivisvanathan (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Included a mixed population of suspected prostate cancer and proven prostate cancer with no sub group analysis</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kravchick (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patients with Persistently Elevated PSA and Negative Results of TRUS-Biopsy: Does 6-Month Treatment with Dutasteride can Indicate Candidates for Re-Biopsy. What is the Best of Saturation Schemes: Transrectal or Transperineal Approach?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kroenig (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic Accuracy of Robot-Guided, Software Based Transperineal MRI/TRUS Fusion Biopsy of the Prostate in a High Risk Population of Previously Biopsy Negative Men</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lai (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Co-registration of MRI and ultrasound: Accuracy of targeting based on radiology-pathology correlation</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lane (2008)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saturation Technique Does Not Decrease Cancer Detection During Followup After Initial Prostate Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Le (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Targeted prostate biopsy: Value of multiparametric magnetic resonance imaging in detection of localized cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lebovici (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of Endorectal MRI in Romanian Men for High Risk of Prostate Cancer: MRI Findings Compared with Saturation Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study population have high risk prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Visually estimated MRI targeted prostate biopsy could improve the detection of significant prostate cancer in patients with a PSA level <10 ng/mL</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of multiparametric and biparametric MRI in first round cognitive targeted prostate biopsy in patients with PSA levels under 10 ng/mL</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Li (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transrectal saturation technique may improve cancer detection as an initial prostate biopsy strategy in men with prostate-specific antigen <10 ng/ml</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Linder (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lu (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Negative Multiparametric Magnetic Resonance Imaging of the Prostate Predicts Absence of Clinically Significant Prostate Cancer on 12-Core Template Prostate Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people with suspected/low risk/intermediate prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ma (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Role of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Biopsy in Active Surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mabjeesh (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High detection rate of significant prostate tumours in anterior zones using transperineal ultrasound-guided template saturation biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mariotti (2018)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incremental diagnostic value of targeted biopsy using MP-MRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Marra (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pathological concordance between prostate biopsies and radical prostatectomy using transperineal sector mapping biopsies: Validation and comparison with transrectal biopsies</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Martorana (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lesion volume predicts prostate cancer risk and aggressiveness: validation of its value alone and matched with prostate imaging reporting and data system score</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">McCammack (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Restriction spectrum imaging improves MRI-based prostate cancer detection</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Merrick (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal template-guided mapping biopsy identifies pathologic differences between very-low-risk and low-risk prostate cancer: Implications for active surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Merrick (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incidence, grade and distribution of prostate cancer following transperineal template-guided mapping biopsy in patients with atypical small acinar proliferation</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Miakhil (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Predictive value of multiparameteric MRI (MP-MRI) for the detection of prostate cancer using 12-core trus-guided prostate biopsy-a United Kingdom multicenter study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Miano (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal versus transrectal prostate biopsy for predicting the final laterality of prostate cancer: Are they reliable enough to select patients for focal therapy? Results from a multicenter international study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moldovan (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All relevant studies were included in the review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moore (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Image-guided prostate biopsy using magnetic resonance imaging-derived targets: A systematic review</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mukherjee (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging-directed transperineal limited-mapping prostatic biopsies to diagnose prostate cancer: A scottish experience</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Muthigi (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Missing the Mark: prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nakai (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal template-guided saturation biopsy aimed at sampling one core for each milliliter of prostate volume: 103 cases requiring repeat prostate biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Numao (2007)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Improved Accuracy in Predicting the Presence of Gleason Pattern 4/5 Prostate Cancer by Three-Dimensional 26-Core Systematic Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oberlin (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic Value of Guided Biopsies: Fusion and Cognitive-registration Magnetic Resonance Imaging Versus Conventional Ultrasound Biopsy of the Prostate</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ong (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal biopsy prostate cancer detection in first biopsy and repeat biopsy after negative transrectal ultrasound-guided biopsy: The Victorian Transperineal Biopsy Collaboration experience</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Orczyk (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Should we aim for the centre of an MRI prostate lesion? Correlation between MP-MRI and 3-dimensional 5mm transperineal prostate mapping biopsies from the promis trial</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pal (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2011)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does an inflammatory pattern at primary biopsy suggest a lower risk for prostate cancer at repeated saturation prostate biopsy?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anterior prostate biopsy at initial and repeat evaluation: is it useful to detect significant prostate cancer?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can 3-tesla pelvic phased-array multiparametric MRI avoid unnecessary repeat prostate biopsy in patients with PSA < 10 ng/mL?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol Saturation biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Detection rate for significant cancer at confirmatory biopsy in men enrolled in Active Surveillance protocol: 20 cores vs 30 cores vs MRI/TRUS fusion prostate biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol Saturation Biopsy also known TRUS</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confirmatory biopsy of men under active surveillance: extended versus saturation versus multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol extended and saturation biopsy both are TRUS biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric MRI/TRUS fusion prostate biopsy: Advantages of a transperineal approach</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Men with no suspicious lesions were excluded from the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pepe (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal Versus Transrectal MRI/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pessoa (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol TRUS biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pokharel (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multi-parametric MRI findings of transitional zone prostate cancers: correlation with 3-dimensional transperineal mapping biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Included a mixed population of suspected prostate cancer and proven prostate cancer with no sub group analysis</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Raber (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does the transrectal ultrasound probe influence prostate cancer detection in patients undergoing an extended prostate biopsy scheme? Results of a large retrospective study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Radtke (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparative Analysis of Transperineal Template Saturation Prostate Biopsy Versus Magnetic Resonance Imaging Targeted Biopsy with Magnetic Resonance Imaging-Ultrasound Fusion Guidance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Only included population with negative TRUS/MRI results</p>
|
|
<p>The reference standard was carried out in patients who had lesions classed as PIRADS 2-5</p>
|
|
</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Radtke (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Duplicate reference</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reis (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gleason underestimation is predicted by prostate biopsy core length</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Robertson (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prostate cancer risk inflation as a consequence of image-targeted biopsy of the prostate: A computer simulation study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Russo (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Detection of prostate cancer index lesions with multiparametric magnetic resonance imaging (mp-MRI) using whole-mount histological sections as the reference standard</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Salami (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric magnetic resonance imaging outperforms the prostate cancer prevention trial risk calculator in predicting clinically significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Scheltema (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preliminary Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Focal Therapy with Irreversible Electroporation</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people with suspected/low risk/intermediate prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schimmoller (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schimmoller (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MRI-guided in-bore biopsy: Differences between prostate cancer detection and localization in primary and secondary biopsy settings</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schoots (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance Imaging-targeted Biopsy May Enhance the Diagnostic Accuracy of Significant Prostate Cancer Detection Compared to Standard Transrectal Ultrasound-guided Biopsy: A Systematic Review and Meta-analysis</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Scott (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Is transperineal prostate biopsy more accurate than transrectal biopsy in determining final Gleason score and clinical risk category? A comparative analysis</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a relevant study design (cross sectional study)</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sheikh (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shen (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The results of transperineal versus transrectal prostate biopsy: A systematic review and meta-analysis</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a relevant study design (cross sectional study)</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shin (2018)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy of a five-point Likert scoring system for magnetic resonance imaging (MRI) evaluated according to results of MRI/ultrasonography image-fusion targeted biopsy of the prostate</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shoji (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Manually controlled targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: An early experience</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shoji (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Accuracy of real-time magnetic resonance imaging-transrectal ultrasound fusion image-guided transperineal target biopsy with needle tracking with a mechanical position-encoded stepper in detecting significant prostate cancer in biopsy-naive men</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shukla-Dave (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Role of MRI in prostate cancer detection</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sim (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evaluation of tumor morphologies at radical prostatectomy in high risk gleason score >9 prostate cancer diagnosed at trus-guided biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Taira (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal template-guided mapping biopsy as a staging procedure to select patients best suited for active surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Takuma (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal ultrasound-guided multiple core biopsy using template for patients with one or more previous negative biopsies: comparison with systematic 10-core biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Taneja (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Re: Diagnostic Accuracy of Multi-Parametric MRI and TRUS Biopsy in Prostate Cancer (PROMIS): A Paired Validating Confirmatory Study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tay (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Focal Therapy for Prostate Cancer with In-Bore MR-guided Focused Ultrasound: Two-Year Follow-up of a Phase I Trial-Complications and Functional Outcomes</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No reference standard</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Taymoorian (2007)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transrectal broadband-Doppler sonography with intravenous contrast medium administration for prostate imaging and biopsy in men with an elevated PSA value and previous negative biopsies</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant index tests</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tewes (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thestrup (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Biparametric versus multiparametric MRI in the diagnosis of prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thompson (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: A prospective study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thompson (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective study of pre-biopsy multiparametric magnetic resonance imaging (MP-MRI) compared to transperineal template mapping biopsy (TTMB) for detection of clinically significant prostate cancer: is it accurate enough to guide selection of men for biopsy?</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thompson (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medium-term oncological outcomes for extended vs saturation biopsy and transrectal vs transperineal biopsy in active surveillance for prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thompson (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The diagnostic performance of multiparametric magnetic resonance imaging to detect significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>only included population with negative TRUS/MRI results</p>
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<p>Biopsy only carried out in those with MP-MRI SCORES OF 3-5</p>
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|
</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thompson (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy of multi-parametric MRI and transrectal ultrasound-guided biopsy in prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ting (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment of the Performance of Magnetic Resonance Imaging/Ultrasound Fusion Guided Prostate Biopsy against a Combined Targeted Plus Systematic Biopsy Approach Using 24-Core Transperineal Template Saturation Mapping Prostate Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Toner (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All relevant studies were included in the review</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tran (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance Imaging-Ultrasound Fusion Biopsy During Prostate Cancer Active Surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Valerio (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Visually directed vs. software-based targeted biopsy compared to transperineal template mapping biopsy in the detection of clinically significant prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Men with no suspicious lesions were excluded from the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Van Vugt (2012)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective validation of a risk calculator which calculates the probability of a positive prostate biopsy in a contemporary clinical cohort</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Walton (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wang (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evaluation of multiparametric magnetic resonance imaging in detection and prediction of prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wang (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Primary prostate cancer imaging with MP-MRI, PET/CT and PET/MRI with focus on localisation and grading</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Weaver (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Presence of magnetic resonance imaging suspicious lesion predicts gleason 7 or greater prostate cancer in biopsy-naive patients</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not possible to calculate a 2x2 table from data presented in the study</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wegelin (2016)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">An Ex Vivo Phantom Validation Study of an MRI-Transrectal Ultrasound Fusion Device for Targeted Prostate Biopsy</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people with suspected/low risk/intermediate prostate cancer</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Westhoff (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people with suspected/low risk/intermediate prostate cancer The study is ex vivo</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Winter (2013)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A systematic review with metaanalysis of transrectal prostate biopsy versus transperineal prostate biopsy for detecting prostate cancer</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wu (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">T2* mapping combined with conventional T2-weighted image for prostate cancer detection at 3.0T MRI: A multi-observer study</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wysock (2014)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yoo (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Is suspicious upstaging on multiparametric magnetic resonance imaging useful in improving the reliability of Prostate Cancer Research International Active Surveillance (PRIAS) criteria? Use of the K-CaP registry</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhang (2015)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Free-hand transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: single-center experience in China</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Men with no suspicious lesions were excluded from the study</p>
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<p>Population was restricted to those with PIRAD classification between 2 and 5 according to the MP-MRI</p>
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</td></tr><tr><td headers="hd_h_chd.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhang (2017)</td><td headers="hd_h_chd.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of free-hand transperineal MP-MRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: a single-center prospective study in China</td><td headers="hd_h_chd.apph.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard in study does not match that specified in protocol TRUS biopsy</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdapphtab2"><div id="chd.apph.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.apph.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.apph.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Short Title</th><th id="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Title</th><th id="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for Exclusion</th></tr></thead><tbody><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arsov (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people who are biopsy naive</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arsov (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective randomized study comparing MR-guided in-bore versus MRI/ultrasound fusion guided prostate biopsy in patients with prior tumor-negative TRUS biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arsov (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of patient comfort between MR-guided in-bore and MRI/ultrasound fusion-guided prostate biopsies within a prospective randomized trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Baur (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective study investigating the impact of multiparametric MRI in biopsy-naive patients with clinically suspected prostate cancer: The PROKOMB study</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Study does not contain any relevant interventions</p>
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<p>Not a randomised controlled trial</p>
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</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cam (2008)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Combined periprostatic and intraprostatic local anesthesia for prostate biopsy: a double-blind, placebo controlled, randomized trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chae (2009)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The comparison between transperineal and transrectal ultrasound-guided prostate needle biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study not reported in English</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Choi (2011)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective evaluation of 3T magnetic resonance imaging performed prior to an initial transrectal ultrasound-guided biopsy in the detection of prostate cancer</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cicione (2012)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prostate biopsy quality is independent of needle size: a randomized single-center prospective study</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Davuluri (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Comparison of Magnetic Resonance Image-Guided Targeted Biopsy Versus Standard Template Saturation Biopsy in the Detection of Prostate Cancer</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dell’Oglio (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inclusion of mpMRI into the European Randomized study of Screening for Prostate Cancer (ERSPC) risk calculator: a new proposal to improve the accuracy of prostate cancer detection</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic performance... (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: is it possible to spare cores with contrast-guided biopsy?</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a randomised controlled trial</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DiBianco (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound Guided, Freehand Transperineal Prostate Biopsy: An Alternative to the Transrectal Approach</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a randomised controlled trial</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fiard (2013)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Targeted MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a randomised controlled trial</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Garcia (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal versus transrectal prostate biopsy in prostate cancer detection: a systematic review with meta-analysis</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Garcia (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does transperineal prostate biopsy reduce complications compared with transrectal biopsy? A systematic review and metaanalysis of randomised controlled trials</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gayet (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy platforms in prostate cancer detection: a systematic review</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review - looking at diagnostic test accuracy studies</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Grenabo (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Role of Magnetic Resonance Imaging in Prostate Cancer Screening: a Pilot Study Within the Göteborg Randomised Screening Trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people who biopsy naive</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Grummet (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal vs. transrectal biopsy in MRI targeting</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guo (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: a Prospective, Randomized, and Controlled Trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Duplicate reference</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guo (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized, and Controlled Trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator in study does not match that specified in protocol both arms are systematic biopsy</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Halpern (2012)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Contrast enhanced transrectal ultrasound for the detection of prostate cancer: a randomized, double-blind trial of dutasteride pretreatment</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hara (2008)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Optimal approach for prostate cancer detection as initial biopsy: prospective randomized study comparing transperineal versus transrectal systematic 12-core biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Comparator in study does not match that specified in protocol</p>
|
|
<p>Both arms are systematic biopsies</p>
|
|
</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kasivisvanathan (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A randomized controlled trial to investigate magnetic resonance imaging-targeted biopsy as an alternative diagnostic strategy to transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a randomised controlled trial</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kasivisvanathan (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A multicentre randomised controlled trial assessing whether MRI-targeted biopsy is non-inferior to standard transrectal ultrasound guided biopsy for the diagnosis of clinically significant prostate cancer in men without prior biopsy: a study protocol</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study Protocol</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Klotz (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging-targeted vs. systematic biopsies in men on active surveillance: results of a prospective, randomized Canadian Urology Research Consortium trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leitao (2011)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective randomized trial of prostate biopsy protocols comparing the vienna nomogram and a standard 10-core biopsy scheme</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leitao (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A Prospective Randomized Trial Comparing the Vienna Nomogram and a Ten-Core Prostate Biopsy Protocol: Effect on Cancer Detection Rate</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lenherr (2013)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Real-time-elastography (RTE): its detection rate compared to multiple core biopsy and an evaluation of psa and prostate volume as predictors</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mitterberger (2007)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective randomized trial comparing contrast-enhanced targeted versus systematic ultrasound guided biopsies: impact on prostate cancer detection</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Panebianco (2010)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Role of magnetic resonance spectroscopic imaging ([1H]MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate-specific antigen (PSA)</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study does not contain any relevant interventions</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Panebianco (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Park (2011)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Duplicate reference</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Porpiglia (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective randomized study comparing standard prostate biopsy and a new diagnostic path with MRI and fusion biopsy: results after two years</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Porpiglia (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard prostate biopsy Versus MRI-fusion biopsy: results after two years of a prospective randomized study</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sciarra (2012)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiparametric magnetic resonance imaging of the prostate can improve the predictive value of the urinary prostate cancer antigen 3 test in patients with elevated prostate-specific antigen levels and a previous negative biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people who are biopsy naive</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shah (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review article but not a systematic review</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh (2017)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of infective complications in transperineal versus transrectal ultrasound guided prostatic biopsy in patients suspected to have prostate cancer</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Takenaka (2008)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Comparator in study does not match that specified in protocol</p>
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<p>both arms are systematic biopsy</p>
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</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Takuma (2012)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal ultrasound-guided multiple core biopsy using template for patients with one or more previous negative biopsies: comparison with systematic 10-core biopsy</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Taverna (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does not contain a population of people who are biopsy naive</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thompson (2015)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective study of pre-biopsy multiparametric magnetic resonance imaging (MPMRI) compared to transperineal template mapping biopsy (TTMB) for detection of clinically significant prostate cancer: is it accurate enough to guide selection of men for biopsy?</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">van Hove (2014)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review - all relevant studies have been included in this review</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wegelin (2016)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">An interim analysis of the FUTURE trial; A RCT on three techniques of target prostate biopsy based on MR imaging. Comparison of detection rates of (significant) prostate cancer</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_chd.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Winter (2013)</td><td headers="hd_h_chd.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A systematic review with metaanalysis of transrectal prostate biopsy versus transperineal prostate biopsy for detecting prostate cancer</td><td headers="hd_h_chd.apph.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdapphtab3"><div id="chd.apph.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.apph.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.apph.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Short Title</th><th id="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Title</th><th id="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Venderink et al. 2017</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not using the trans-perineal mapping biopsy as a reference</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Willis et al 2015</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A review of economic evaluations of diagnostic strategies using imaging in men at risk of prostate cancer</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review reporting already identified studies</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pahwa et al 2017</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not using the trans-perineal mapping biopsy as a reference</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Loeb et al 2017</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Men diagnosed with localised PC. Not using the trans-perineal mapping biopsy as a reference</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gordon et al 2017</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-effectiveness analysis of multiparametric MRI with increased active surveillance for low-risk prostate cancer in Australia</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Men diagnosed with localised PC. Not using the trans-perineal mapping biopsy as a reference</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Do Rooij et al 2014</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not using the trans-perineal mapping biopsy as a reference</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cerantola et al 2016</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not using the trans-perineal mapping biopsy as a reference</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mowatt et al 2013</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Different population (patients with previous negative biopsy)</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hovels et al 2009</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-effectiveness of MR lymphography for the detection of lymph node metastases in patients with prostate cancer</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">population and comparator out of the scope (MR Lymphography for the Detection of Lymph Node Metastases in Patients with Prostate Cancer</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roth et al 2015</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost-Effectiveness of a Biopsy-Based 8-Protein Prostate Cancer Prognostic Assay to Optimize Treatment Decision Making in Gleason 3 + 3 and 3 + 4 Early Stage Prostate Cancer</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparators out of the scope (PCA3)</td></tr><tr><td headers="hd_h_chd.apph.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nicholson et al 2015</td><td headers="hd_h_chd.apph.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The clinical effectiveness and cost-effectiveness of the PROGENSA prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation</td><td headers="hd_h_chd.apph.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparators out of the scope (PCA3)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappjtab1"><div id="chd.appj.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Question</th><th id="hd_h_chd.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">In patients with negative MRI (Likert score 1 or 2), what is the next best diagnostic investigation to rule out clinically significant prostate cancer?</th></tr></thead><tbody><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_chd.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with negative MRI (Likert score 1 or 2)</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index tests</td><td headers="hd_h_chd.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any test given within 6 months of MRI to further exclude clinically significant prostate cancer.</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</td><td headers="hd_h_chd.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Biopsy</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_chd.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Sensitivity</p>
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<p>Specificity</p>
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<p>Positive and negative likelihood ratios</p>
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<p>QoL outcomes</p>
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<p>Adverse events</p>
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</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</td><td headers="hd_h_chd.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic cross sectional studies</td></tr><tr><th headers="hd_h_chd.appj.tab1_1_1_1_1" id="hd_b_chd.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potential criterion</th><th headers="hd_h_chd.appj.tab1_1_1_1_2" id="hd_b_chd.appj.tab1_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Explanation</th></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1 hd_b_chd.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to patients, service users or the population</td><td headers="hd_h_chd.appj.tab1_1_1_1_2 hd_b_chd.appj.tab1_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The evidence shows that about 20% of men with a Likert score 1 or 2 on MRI may have clinically significant cancer. Since the new pathway discourages biopsy in men with negative MRI, the research will help formulate a pathway that these people may follow to identify any missed clinically significant cancer</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1 hd_b_chd.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</td><td headers="hd_h_chd.appj.tab1_1_1_1_2 hd_b_chd.appj.tab1_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current guidance on the follow-up protocol for men with negative is not evidence based as this is a new population as a result as the new pathway.</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1 hd_b_chd.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</td><td headers="hd_h_chd.appj.tab1_1_1_1_2 hd_b_chd.appj.tab1_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Limited evidence as this population is relatively new</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1 hd_b_chd.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</td><td headers="hd_h_chd.appj.tab1_1_1_1_2 hd_b_chd.appj.tab1_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No additional equality issues are envisaged relating to this study over and above those applying generally to vulnerable groups of people.</td></tr><tr><td headers="hd_h_chd.appj.tab1_1_1_1_1 hd_b_chd.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Feasibility</td><td headers="hd_h_chd.appj.tab1_1_1_1_2 hd_b_chd.appj.tab1_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A large enough number of people receive a MRI of the prostate to make this study feasible.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchdappjtab2"><div id="chd.appj.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576979/table/chd.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Question</th><th id="hd_h_chd.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">What is the diagnostic accuracy of transperineal mapping biopsy versus transperineal non mapping biopsy in the diagnosis of clinically significant prostate cancer?</th></tr></thead><tbody><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_chd.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People suspected of cancer (biopsy naïve or repeat biopsy)</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test</td><td headers="hd_h_chd.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal non mapping biopsy</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">References</td><td headers="hd_h_chd.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Transperineal mapping biopsy</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_chd.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Sensitivity</p>
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<p>Specificity</p>
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<p>Positive and Negative Likelihood ratios</p>
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</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</td><td headers="hd_h_chd.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic cross sectional studies</td></tr><tr><th headers="hd_h_chd.appj.tab2_1_1_1_1" id="hd_b_chd.appj.tab2_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potential criterion</th><th headers="hd_h_chd.appj.tab2_1_1_1_2" id="hd_b_chd.appj.tab2_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Explanation</th></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1 hd_b_chd.appj.tab2_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to patients, service users or the population</td><td headers="hd_h_chd.appj.tab2_1_1_1_2 hd_b_chd.appj.tab2_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The committee explained that a number of providers across the country use the transperineal route for biopsy rather than the transrectal route, however transperineal biopsy can be a mapping biopsy where a large number of samples are taken from around the prostate (currently considered the ‘gold standard’ diagnostic test) or a non-mapping biopsy where a smaller number of samples are taken in a more focussed way (for example guided by MRI). The diagnostic accuracy of the non-mapping method is not known.</p>
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<p>Transperineal mapping biopsy is more resource intensive than non-mand the NHS is not equipped to perform a large number of these.</p>
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</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1 hd_b_chd.appj.tab2_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</td><td headers="hd_h_chd.appj.tab2_1_1_1_2 hd_b_chd.appj.tab2_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This research will enable NICE guideline to be more specific about which biopsy is most appropriate in which situation.</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1 hd_b_chd.appj.tab2_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</td><td headers="hd_h_chd.appj.tab2_1_1_1_2 hd_b_chd.appj.tab2_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The current evidence base suggests that transperineal template biopsy is the most accurate diagnostic tool for prostate cancer. It is unknown how non-mapping transperineal biopsy compares to this.</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1 hd_b_chd.appj.tab2_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</td><td headers="hd_h_chd.appj.tab2_1_1_1_2 hd_b_chd.appj.tab2_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No additional equality issues are envisaged relating to this study over and above those applying generally to vulnerable groups of people.</td></tr><tr><td headers="hd_h_chd.appj.tab2_1_1_1_1 hd_b_chd.appj.tab2_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Feasibility</td><td headers="hd_h_chd.appj.tab2_1_1_1_2 hd_b_chd.appj.tab2_1_1_6_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">There is a large enough population of people with locally advanced prostate cancer, carrying out a trial in this area should be feasible</td></tr></tbody></table></div></div></article><article 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