The utility of prostate MRI within active surveillance: description of the evidence

Wayne G. Brisbane,Georgina Dominique,Robert E. Reiter

doi:10.1007/s00345-021-03853-9

Abstract

PurposeWe present an overview of the literature regarding the use of MRI in active surveillance of prostate cancer.MethodsBoth MEDLINE® and Cochrane Library were queried up to May 2020 for studies of men on active surveillance with MRI and later confirmatory biopsy. The terms studied were ‘prostate cancer’ as the anchor followed by two of the following: active surveillance, surveillance, active monitoring, MRI, NMR, magnetic resonance imaging,  MRI, and multiparametric MRI. Studies were excluded if pathologic reclassification (GG1 → ≥ GG2) and PI-RADS or equivalent was not reported.ResultsWithin active surveillance, baseline MRI is effective for identifying clinically significant prostate cancer and thus associated with fewer reclassification events. A positive initial MRI (≥ PI-RADS 3) with GG1 identified at biopsy has a positive predictive value (PPV) of 35–40% for reclassification by 3 years. MRI possessed a stronger negative predictive value, with a negative MRI (≤ PI-RADS 2) yielding a negative predictive value of up to 85% at 3 years. Surveillance MRI, obtained after initial biopsy, yielded a PPV of 11–65% and NPV of 85–95% for reclassification.ConclusionMRI is useful for initial risk stratification of prostate cancer in men on active surveillance, especially if MRI is negative when imaging is obtained during surveillance. While useful, MRI cannot replace biopsy and further research is necessary to fully integrate MRI into active surveillance.

Highlights

Prostate cancer is the most common internal malignancy in men [1]
As Magnetic resonance imaging (MRI) is increasingly included among the first line diagnostic tests for elevated PSA, it is likely that patients will continue to benefit from the increasing accuracy of prostate cancer risk stratification
If patients are diagnosed with GG1 prostate cancer using transrectal ultrasound (TRUS) biopsy, clinicians should consider confirmatory biopsy using MRI guidance as this is associated with higher rates of reclassification [30] (Table 2)

Summary

Introduction

Prostate cancer is the most common internal malignancy in men [1]. 190,000 new cases and 33,000 deaths are expected during 2020, making it the second most common cause of cancer death in men [2]. A large number of men present with low-risk prostate cancer, and when monitored with active surveillance have less than a 2% risk of cancer-specific mortality over 10 years [3]. Prostate cancer diagnosis guided by transrectal ultrasound (TRUS). May miss higher risk prostate cancer [4]. Magnetic resonance imaging (MRI) of the prostate has emerged as a diagnostic modality to identify prostate cancer and guide biopsy. Compared to TRUS, MRI guided biopsy is more accurate for the diagnosis of prostate cancer [4]

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