MRI and active surveillance: thoughts from across the pond

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Active surveillance (AS) is recommended for low-risk prostate cancer (PCa) and an option for favorable intermediate-risk PCa in the US.
• Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for PCa screening, monitoring, and staging.
• Current US guidelines recommend mpMRI for AS but lack specific guidance on follow-up timing and emphasize it should not replace biopsies.

Purpose of the Study:

• To review the current literature on using mpMRI for patients with PCa on active surveillance, focusing on the US approach.
• To discuss the role of mpMRI in augmenting risk stratification and monitoring within AS protocols.
• To highlight the importance of a multimodal approach integrating mpMRI with PSA kinetics and biopsies.

Main Methods:

• Review of current literature on mpMRI utilization in prostate cancer active surveillance.
• Analysis of US urological guidelines, including American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) recommendations.
• Focus on the integration of mpMRI findings with diagnostic, confirmatory, and follow-up biopsies.

Main Results:

• The addition of mpMRI to diagnostic and monitoring protocols for AS patients shows benefits in detecting clinically significant PCa.
• There is no strong evidence to support mpMRI replacing periodic surveillance biopsies for most AS patients.
• The optimal timing for follow-up mpMRI in AS patients remains unclear and is not specifically addressed in current guidelines.

Conclusions:

• mpMRI is a valuable tool for monitoring prostate cancer in men on active surveillance, improving detection and risk stratification.
• mpMRI should be incorporated into a multimodal approach, complementing PSA kinetics and surveillance biopsies.
• Further research is needed to clarify the optimal timing for follow-up mpMRI in AS protocols.