Is MRI ready to replace biopsy during active surveillance?

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Active surveillance (AS) is a management strategy for low- and selected intermediate-risk prostate cancer (PCa).
• Multiparametric MRI (mpMRI) is increasingly adopted in the primary diagnosis and AS of PCa.
• The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) criteria guide AS protocols.

Purpose of the Study:

• To review the role and performance of mpMRI throughout the prostate cancer active surveillance pathway.
• To evaluate mpMRI's utility in patient selection, risk stratification, and monitoring disease progression relative to PRECISE criteria.
• To identify areas for improvement in mpMRI application within AS.

Main Methods:

• Systematic review of existing literature on mpMRI in prostate cancer active surveillance.
• Analysis of mpMRI performance in initial patient stratification and follow-up assessments.
• Evaluation of mpMRI's concordance with biopsy findings and clinical outcomes.

Main Results:

• mpMRI demonstrates high negative predictive value for detecting clinically significant PCa (csPCa), supporting its use in initial selection and stratification.
• Evidence regarding mpMRI's efficacy in monitoring disease progression during AS is conflicting.
• MRI-negative csPCa, optimal MRI protocols (including biparametric MRI), and the integration of artificial intelligence (AI) require further investigation.

Conclusions:

• mpMRI is essential for patient selection, risk stratification, and follow-up in prostate cancer AS.
• mpMRI cannot fully replace biopsies in AS due to current limitations.
• Standardizing MRI protocols is critical to overcome limitations and enhance the effectiveness of mpMRI in AS for prostate cancer.