Dias, Adriano B; Woo, Sungmin; Leni, Riccardo; Rajwa, Pawel; Kasivisvanathan, Veeru; Ghai, Sangeet; Haider, Masoom; ... Brembilla, Giorgio; + view all Dias, Adriano B; Woo, Sungmin; Leni, Riccardo; Rajwa, Pawel; Kasivisvanathan, Veeru; Ghai, Sangeet; Haider, Masoom; Gandaglia, Giorgio; Brembilla, Giorgio; - view fewer (2024) Is MRI ready to replace biopsy during active surveillance? European Radiology , 34 pp. 7716-7727. 10.1007/s00330-024-10863-9.

Text Kasivisvanathan_Final accepted Is MRI ready to replace biopsy during active surveillance.pdf Access restricted to UCL open access staff until 5 July 2025. Download (172kB)

Abstract

Active surveillance (AS) is a conservative management option recommended for patients diagnosed with low-risk prostate cancer (PCa) and selected cases with intermediate-risk PCa. The adoption of prostate MRI in the primary diagnostic setting has sparked interest in its application during AS. This review aims to examine the role and performance of multiparametric MRI (mpMRI) across the entire AS pathway, from initial stratification to follow-up, also relative to the utilization of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) criteria. Given the high negative predictive value of mpMRI in detecting clinically significant PCa (csPCa), robust evidence supports its use in patient selection and risk stratification at the time of diagnosis or confirmatory biopsy. However, conflicting results have been observed when using MRI in evaluating disease progression during follow-up. Key areas requiring clarification include addressing the clinical significance of MRI-negative csPCa, optimizing MRI quality, determining the role of biparametric MRI (bpMRI) or mpMRI protocols, and integrating artificial intelligence (AI) for improved performance.

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