The MRI pathway comprises two components: MRI (suspicion score) and MRI‐targeted biopsy in the presence of suspicious lesions for clinically significant prostate cancer:

• a) MRI suspicion score: refers to only the first component of the MRI pathway.

• b) MRI±MRI‐TBx: refers to both components of the MRI pathway.

Review design

Meta‐analysis of studies reporting on:

The MRI pathway and the reference standard: ·

• Comparison 1a: MRI suspicion score vs reference standard and all additional biopsies (e.g. MRI‐targeted biopsies).

• Comparison 1b: MRI±MRI‐TBx vs reference standard.

TRUS‐guided biopsy and reference standard: ·

• Comparison 2

MRI pathway B) MRI±MRI‐TBx and TRUS‐guide biopsy:

• Comparison 3

A combination of all tests:

• Comparison 4: comparing both index tests, either directly with the reference standard or indirectly as a randomised trial of test accuracy.

Two‐by‐two contingency tables for target condition.

Comparison 1a: MRI suspicion score vs reference standard (if MRI‐targeted biopsies are performed these will serve as additional reference biopsies).

Comparison 1b: MRI±MRI‐TBx vs reference standard.

Comparison 2: TRUS‐guided biopsy vs reference standard.

Comparison 3: MRI±MRI‐TBx vs TRUS‐guided biopsy.

For comparison 1b and comparison 3, a negative test can result in two ways:

1. a negative MRI (thus no MRI‐targeted biopsies are taken).

2. a positive MRI but negative MRI‐targeted biopsy result.

Both negative outcomes should be merged, creating a two‐by‐two from a three‐by‐two contingency table (first and second column).

In comparison 3 the TRUS‐guided biopsy is not a proper reference standard. Therefore we will focus on the number of cancers identified and the concordance and disconcordance between both index tests.

TP = true positive; FP = false positive; TN = true negative; FN = false negative; Dposneg = Discordant MRI positive + targeted biopsies positive and TRUS‐guided biopsies negative; Dnegpos = Discordant MRI positive/negative + targeted biopsies negative and TRUS‐guided biopsies positive.