Multiparametric Magnetic Resonance Imaging for Active Surveillance of Prostate Cancer

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Active surveillance is a viable option for low-risk prostate cancer, aiming to reduce overtreatment morbidity.
• Accurate identification of low-risk patients is crucial for successful active surveillance.
• Current methods often fail to reliably exclude high-risk disease, hindering confidence in active surveillance.

Purpose of the Study:

• To evaluate the role of multiparametric MRI (mpMRI) in selecting patients for active surveillance of prostate cancer.
• To explore how mpMRI can improve the accuracy of identifying clinically significant prostate cancer lesions.

Main Methods:

• Utilizing multiparametric MRI (mpMRI), which combines multiple MRI sequences (T2-weighted, diffusion-weighted, dynamic contrast-enhanced).
• Incorporating the Prostate Imaging-Reporting and Data System (PI-RADS) version 2 criteria for standardized interpretation.
• Assessing the ability of mpMRI to differentiate between low-risk and high-risk prostate cancer lesions.

Main Results:

• Preliminary data suggest mpMRI can aid in selecting appropriate candidates for active surveillance.
• mpMRI may help identify missed high-grade lesions, preventing their inclusion in surveillance protocols.
• mpMRI can also reassure patients with minimal disease, facilitating their participation in active surveillance.

Conclusions:

• Multiparametric MRI (mpMRI) shows potential as a valuable tool for selecting patients for active surveillance in low-risk prostate cancer.
• Further validation studies are needed, particularly for its role in monitoring patients already on active surveillance.
• Addressing challenges like cost, access, and standardization is key to the routine adoption of mpMRI in prostate cancer management.