Is biparametric MRI a feasible option for detecting clinically significant prostate cancer?: A systematic review and meta-analysis

•Mp-MRI, although its efficacy has been questioned regarding cost-benefit.•This Meta-analysis assessed the results of Biparametric MRI for CsPca detection.•A total of 534 articles were filtered obtaining 19 articles with 5075 patients.•The estimated pooled results were sensitivity 0.89, specificity 0.73 and AUC 0.90.•Results demonstrated that it could be a feasible alternative for CsPca detection. Multiparametric MRI (Mp-MRI) is a key tool to screen for Prostate Cancer (Pca) and Clinically Significant Prostate Cancer (CsPca). It primarily includes T2-Weighted imaging (T2w), diffusion-weighted imaging (DWI), and Dynamic Contrast-Enhanced imaging (DCE). Despite its improvements in CsPca screening, concerns about the cost-effectiveness of DCE persist due to its associated side effects, increased cost, longer acquisition time, and limitations in patients with poor kidney function. Recent studies have explored Biparametric MRI (Bp-MRI) as an alternative that excludes DCE. The main objective of this study is to compile and evaluate updated results of Bp-MRI as a diagnostic alternative to detect CsPca. A systematic review was conducted using PubMed, Central Cochrane, and ClinicalTrialls.gov registry. Inclusion criteria was focused on observational and experimental studies that assessed a direct comparison of Bp-MRI and Mp-MRI for CsPca detection. The primary outcomes included were necessary to create a contingency 2×2 table and CsPca prevalence from each study. The secondary outcomes included were demographic data and imaging protocol features. The statistical analysis used a Bivariate Random-Effect model to estimate the pooled sensitivity, specificity, and area under the curve (AUC). An univariate random-effect model was conducted to estimate the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies -2 tool. From 534 articles initially identified, 19 studies met the inclusion criteria with a total of 5075 patients. The pooled sensitivity estimated was 0.89, pooled specificity was 0.73, and AUC was 0.90; these results showed a slight increase compared to previous studies. The results obtained showed that Bp-MRI is a feasible alternative to detect CsPca, which demonstrates high diagnostic accuracy and avoids the drawbacks associated with DCE. This is a sub-analysis of the protocol registered at PROSPERO (CRD42024552125).