Magnetic resonance imaging-targeted prostate biopsies: now is the time to START.


It has been a decade since the publication of the Standards for Reporting of Diagnostic Accuracy (STARD) [1], a detailed set of recommendations for reporting and reviewing studies evaluating the accuracy of diagnostic medical tests. Many journals now require adherence to these recommendations, which were developed in consensus by researchers, editors, and members of professional organizations. Although not universally followed, the STARD recommendations serve as an important reminder of the broader need for standardization of research practices. In this issue of European Urology, Moore et al. present ‘‘Standards of Reporting for MRI-Targeted Biopsy Studies (START) of the Prostate: Recommendations from an International Working Group,’’ a consensus-based document modeled on STARD [2]. The need for the START consensus documentwas brought to light by a recent meta-analysis of studies of magnetic resonance imaging (MRI)-targeted prostate biopsy [3]. The meta-analysis (of which Moore was also the lead author) found that while MRI-targeted and standard biopsy approachesdetectedcancerat similar rates, theMRI-targeted approach decreased the diagnosis of clinically insignificant cancers and reduced the percentage of men with abnormal prostate-specific antigen or digital rectal examination findings who required biopsy [3]. However, no robust prospective multicenter trials of MRI-targeted prostate biopsies were identified. The authors noted that few of the studies analyzed had followed STARD and that the wide variability in research methodology of the existing studies limited the strength of recommendations that could bemade [3]. Given the insufficiency of the existing literature, the START consensus document is a welcome development. The START working group used a formal consensus methodologyadapted fromtheRANDCorporation/University of California, Los Angeles appropriateness method, which outlineshowtocombine thebest available scientific evidence with the collective judgment of experts to yield a statement about the appropriateness of performing a procedure [4]. Valuable features of the START consensus document include definitions of preferred terminology for reporting in studies. For example, separate terms are recommended for describing visual (cognitive) as opposed to software-based image registration methods for identifying a target lesion during biopsy. In addition, the consensus document introduces a 20-item ‘‘START checklist’’ as a guide for authors reporting studies on MRI-targeted prostate biopsies, specifying the details that should be included regarding the methodology, study population, MRI acquisition and interpretation, and conduct of the biopsy procedures, and in the reporting and discussion of the study results. As vividly illustrated in Gawande’s book The Checklist Manifesto, checklists can improve medical practice by allowing complex knowledge to be applied consistently and with relative ease [5]. The START checklist combines often used parameters and is highly practical. It will help investigators design more clinically relevant studies and report the findings more consistently; in turn, this will allowdata frommultiple studies to be pooled and compared to provide a stronger basis for clinical decision making. Although we applaud the initiative of the START working group and praise the precision and clarity with which their findings are presented, we must emphasize some general limitations of consensus methodologies. The authors elegantly dealt with potential biases by including an international mix of well-known and respected clinicians and investigators with solid publication records onMRI-targeted prostate biopsies and/or extensive clinical experience with EU RO P E AN URO LOGY 6 4 ( 2 0 1 3 ) 5 5 3 – 5 5 6

DOI: 10.1016/j.eururo.2013.06.018

Cite this paper

@article{Vargas2013MagneticRI, title={Magnetic resonance imaging-targeted prostate biopsies: now is the time to START.}, author={Hebert Alberto Vargas and Hedvig Hricak}, journal={European urology}, year={2013}, volume={64 4}, pages={553-4} }