Can MRI replace serial biopsies in men on active surveillance for prostate cancer?

Purpose Of Review: The role of MRI in active surveillance to date has been in assessing men with low or intermediate-risk disease to identify those men harbouring higher risk disease undersampled at standard biopsy. MRI as a tool for reassessing men over the surveillance period, as an alternative to repeat standard biopsies, is also of interest.

Recent Findings: Multiple studies suggest that MRI early in active surveillance can identify men whose prostate cancer was undersampled at initial biopsy, and MRI-targeted biopsies can be offered. There are a small number of centres now using MRI in the routine follow-up of men on active surveillance. The presence of a lesion on MRI indicates that a man is at higher likelihood of radiological progression than men with a negative MRI at diagnosis. These findings need to be validated in longer-term studies with predefined criteria for radiological significance and radiological progression.

Summary: MRI is useful in the identification of men with higher-risk prostate cancer prior to commencement of a formal active surveillance programme. It is also of use in following up men on active surveillance, as a way to detect change in tumour over time.