Use of Multi-Parametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance.

To review the role of multi-parametric magnetic resonance imaging (mpMRI) for active surveillance of prostate cancer.

We performed a comprehensive search of Medline and Embase databases for relevant articles. Search terms included prostate cancer, active surveillance or monitoring, expectant management, and MRI in the English language. We also reviewed practice guidelines from recognized international associations or societies involved in prostate cancer care. Articles were selected by both authors for relevance to the subject matter.

The ability of mpMRI to visualize primarily high-grade tumors within the prostate may improve risk stratification for men considering AS for prostate cancer. Multiple mostly single institution studies have found that the addition of mpMRI and a targeted biopsy strategy can improve AS patient selection over standard TRUS biopsy alone. The high negative predictive value of mpMRI may allow men to avoid early repeat biopsy and may offer the possibility to tailor biopsy strategies. The presence of a radiographically positive lesion on mpMRI at baseline predicts for higher likelihood of radiographic progression over time while on AS.

MRI has shown promise in both patient selection and monitoring for men who undergo AS for prostate cancer. There are multiple barriers to widespread utilization of mpMRI for AS including quality, cost, and access to care. This article is protected by copyright. All rights reserved.

BJU international. 2019 Feb 11 [Epub ahead of print]

Allison S Glass, Marc A Dall'Era

Department of Urology and University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.

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