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Updated: May 15, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Evaluation of diffusion-weighted MR imaging at inclusion in an active surveillance protocol for low-risk prostate
Diederik M Somford1, Caroline M Hoeks, Christina A Hulsbergen-van de Kaa
1Department of Urology, Canisius-Wilhelmina Hospital, Radboud University Nijmegen Medical Center, The Netherlands. r.somford@cwz.nl
Purpose:
We aimed to determine whether diffusion-weighted magnetic resonance imaging, by means of the apparent diffusion coefficient (ADC), is able to guide magnetic resonance-guided biopsy in patients fit for active surveillance (AS) and identify patients harboring high-grade Gleason components not suitable for AS.
Materials And Methods:
Our study was approved by the institutional review board of all participating hospitals, and all patients signed informed consent at inclusion. Fifty-four consecutive patients with low-risk prostate cancer (PCa) underwent multiparametric magnetic resonance imaging (MP-MRI) at inclusion for AS. Cancer-suspicious regions (CSRs) upon 3-T MP-MRI were identified in all patients, and magnetic resonance-guided biopsy was performed in all CSRs to obtain histopathological verification. For all CSRs, a median ADC (mADC) was calculated. Wilcoxon signed ranks and Mann-Whitney tests was performed to detect differences between the groups. We used the area under the receiver operating characteristic curve to evaluate the accuracy of mADC to predict the presence of PCa in a CSR. Level of statistical significance was set at P < 0.05.
Results:
Mean mADC in the CSRs with PCa was 1.04 × 10⁻³ mm²/s (SD, 0.29), whereas the CSRs with no PCa displayed a mean mADC of 1.26 × 10⁻³ mm²/s (SD, 0.25; P < 0.001). Cancer-suspicious regions with a high-grade Gleason component displayed a mean mADC of 0.84 × 10⁻³ mm²/s (SD, 0.35) vs a mean mADC for the low-grade CSRs of 1.09 × 10⁻³ mm²/s (SD, 0.25; P < 0.05). A diagnostic accuracy of mADC for predicting the presence of PCa in a CSR with an area under the receiver operating characteristic curve of 0.73 was established (95% confidence interval, 0.61-0.84).
Conclusions:
Median ADC is able to predict the presence and grade of PCa in CSRs identified by MP-MRI.
Insights
Diffusion-weighted MRI apparent diffusion coefficient (ADC) can guide prostate cancer biopsies in patients on active surveillance. This method helps identify high-grade cancer not suitable for surveillance, improving patient selection.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Active surveillance (AS) is a management strategy for low-risk prostate cancer (PCa).
- Accurate identification of high-grade Gleason components is crucial for AS suitability.
- Multiparametric magnetic resonance imaging (MP-MRI) aids in detecting cancer-suspicious regions (CSRs).
Purpose of the Study:
- To evaluate if apparent diffusion coefficient (ADC) from diffusion-weighted MRI can guide magnetic resonance-guided biopsy.
- To determine if ADC can identify patients with high-grade Gleason components unsuitable for AS.
Main Methods:
- Fifty-four patients with low-risk PCa underwent 3-T MP-MRI for AS.
- Magnetic resonance-guided biopsy was performed on all identified CSRs.
- Median ADC (mADC) was calculated for each CSR, and statistical analyses were conducted.
Main Results:
- Mean mADC was significantly lower in CSRs with PCa (1.04 × 10⁻³ mm²/s) compared to those without (1.26 × 10⁻³ mm²/s; P < 0.001).
- CSRs with high-grade Gleason components showed a lower mADC (0.84 × 10⁻³ mm²/s) than low-grade CSRs (1.09 × 10⁻³ mm²/s; P < 0.05).
- The diagnostic accuracy of mADC for predicting PCa presence in CSRs was 0.73 (AUC).
Conclusions:
- Median ADC effectively predicts the presence of prostate cancer in CSRs identified by MP-MRI.
- ADC measurements can aid in grading PCa within CSRs, informing AS decisions.
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