Related Experiment Video
Updated: Feb 6, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Four-year outcomes from a multiparametric magnetic resonance imaging (MRI)-based active surveillance programme: PSA
Kevin Michael Gallagher1, Edward Christopher1,2, Andrew James Cameron1
1Department of Urology, Western General Hospital, Edinburgh, UK.
Objectives:
To report outcomes from a multiparametric (mp) magnetic resonance imaging (MRI)-based active surveillance programme that did not include performing protocol biopsies after the first confirmatory biopsy.
Patients And Methods:
All patients diagnosed with Gleason 3 + 3 prostate cancer because of a raised PSA level who underwent mpMRI after diagnosis were included. Patients were recorded in a prospective clinical database and followed up with PSA monitoring and repeat MRI. In patients who remained on active surveillance after the first MRI (with or without confirmatory biopsy), we investigated PSA dynamics for association with subsequent progression. Comparison between first and second MRI scans was undertaken. Outcomes assessed were: progression to radical therapy at first MRI/confirmatory biopsy and progression to radical therapy in those who remained on active surveillance after first MRI.
Results:
A total of 211 patients were included, with a median of 4.2 years of follow-up. The rate of progression to radical therapy was significantly greater at all stages among patients with visible lesions than in those with initially negative MRI (47/125 (37.6%) vs 11/86 (12.8%); odds ratio 4.1 (95% CI 2.0-8.5), P < 0.001). Only 1/56 patients (1.8%) with negative initial MRI scans who underwent a confirmatory systematic biopsy had upgrading to Gleason 3 + 4 disease. PSA velocity was significantly associated with subsequent progression in patients with negative initial MRI (area under the curve 0.85 [95% CI 0.75-0.94]; P <0.001). Patients with high-risk visible lesions on first MRI who remained on active surveillance had a high risk of subsequent progression 19/76 (25.0%) vs 9/84 (10.7%) for patients with no visible lesions, despite reassuring targeted and systematic confirmatory biopsies and regardless of PSA dynamics.
Conclusion:
Men with low-risk Gleason 3 + 3 prostate cancer on active surveillance can forgo protocol biopsies in favour of MRI and PSA monitoring with selective re-biopsy.
Insights
Men with low-risk prostate cancer on active surveillance can skip routine biopsies. Multiparametric MRI and PSA monitoring can guide treatment decisions, reducing unnecessary procedures.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Active surveillance is a common strategy for managing low-risk prostate cancer.
- Protocol biopsies are traditionally used to monitor disease progression.
- Multiparametric MRI (mpMRI) offers a non-invasive method for assessing prostate cancer.
Purpose of the Study:
- To evaluate the outcomes of an active surveillance program for prostate cancer using mpMRI without routine follow-up biopsies.
- To determine if mpMRI and PSA monitoring can effectively replace confirmatory biopsies in select patients.
- To assess the association between PSA dynamics and disease progression in patients on active surveillance.
Main Methods:
- Inclusion of 211 patients with Gleason 3+3 prostate cancer managed with active surveillance.
- Utilized mpMRI for initial diagnosis and follow-up, alongside PSA monitoring.
- Investigated PSA velocity and MRI findings for correlation with progression to radical therapy.
Main Results:
- Progression to radical therapy was significantly higher in patients with visible lesions on MRI compared to those with negative scans (37.6% vs 12.8%).
- Only 1.8% of patients with initially negative MRI scans showed upgrading to Gleason 3+4 after a confirmatory biopsy.
- PSA velocity was a significant predictor of progression in patients with negative initial MRI scans (AUC 0.85).
Conclusions:
- Men with low-risk Gleason 3+3 prostate cancer can potentially forgo routine protocol biopsies.
- Active surveillance programs can rely on mpMRI and PSA monitoring, with selective re-biopsy when indicated.
- This approach may reduce the need for invasive procedures while effectively monitoring disease.
More Related Videos
Related Concept Videos
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:24Magnetic Resonance Imaging
01:27Imaging Studies IV: Magnetic Resonance Imaging
01:05Atomic Nuclei: Magnetic Resonance
01:07Nuclear Magnetic Resonance (NMR): Overview
NMR spectroscopy generates a spectrum where the characteristic absorption frequencies of the sample are...