Use of mpMRI in active surveillance for localized prostate cancer

• mpMRI has improved the sensitivity and specificity of PSA testing.
• MRI-US fusion is useful for sampling the anterior prostate and effectively targeting biopsies.
• mpMRI allows accurate localization and staging of clinically significant prostate tumors.
• There is a paucity of data regarding use of mpMRI for AS selection and disease monitoring.
• mpMRI may help determine appropriate candidates for adoption and maintenance of AS.

IntroductionIn an effort to limit prostate cancer (PCa) overdiagnosis and overtreatment, which have occurred in response to widespread prostate specific antigen testing, numerous strategies aimed at improved risk stratification of patients with PCa have evolved. Multiparametric magnetic resonance imaging (MRI) is being used in concert with prostate specific antigen testing and prostate biopsies to improve sensitivity and specificity of these tests. There are limited data on how multiparametric MRI can be incorporated into active surveillance (AS) protocols.Evidence acquisitionA PubMed literature search of available English language publications on PCa, AS, and MRI was conducted. Appropriate articles were selected and included for review. Bibliographies were also used to expand our search.Evidence synthesisData from 41 studies were reviewed. AS inclusion criteria and protocols varied among studies, as did indications for use of MRI. Technological improvements are briefly highlighted. Studies are broadly categorized and discussed according to the role of MRI in patient selection, disease staging, and monitoring in AS protocols.ConclusionsAlthough improvements in MRI technology have been useful for biopsy guidance and in the diagnosis and staging of PCa, this literature search demonstrates that more prospective research is needed, specifically regarding how this promising technology can be incorporated into AS protocols.