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MRI-derived radiomics for prostate cancer active surveillance: a systematic review
Eimear T Kyle1, Kevin J Sweeney2, Devin H McCabe3
1School of Medicine, Trinity College Dublin, College Green, Dublin 2 D02 PN40, Ireland; Trinity St James's Cancer Institute, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland; Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
Purpose:
To systematically review MRI-derived radiomic and artificial intelligence models predicting outcomes in men on or eligible for active surveillance (AS) for prostate cancer, and whether reported endpoints permit quantitative synthesis.
Method:
Following PRISMA 2020, we searched PubMed, Scopus, Embase, and Web of Science (2000-September 2026). Two reviewers independently screened, extracted data, and assessed risk of bias (QUADAS-2, PROBAST) and methodological quality (METRICS). Three subgroups were defined: AS selection at diagnosis, baseline detection of clinically significant cancer, and progression during follow-up. Pooling was pre-specified for subgroups with at least four independent cohorts; endpoint equivalence was assessed.
Results:
Seventeen studies across 12 unique cohorts were included. Seven publications derived from two cohorts; 12 independent cohort-level estimates (n = 2703) remained after overlap resolution. Nine publications (four independent cohorts) addressed progression (AUC 0.70 to 0.95), but progression was defined in five non-equivalent ways, from any grade-group increase to composite core-count criteria, precluding quantitative synthesis. Risk of bias was high or unclear in 16 of 17 studies; the median METRICS score was 32.3 % (range 18.9-52.3 %). No study reported external validation or calibration for progression.
Conclusions:
Progression endpoints were heterogeneous and several were of limited clinical relevance. A core outcome set for AS (at least ISUP grade group ≥3 and/or unequivocal radiological progression), followed by multi-centre external validation with a head-to-head comparison against the PRECISE v2 (Prostate Cancer Radiological Estimation of Change in Sequential Evaluation) score, is the priority before clinical use can be considered.