The Role of Magnetic Resonance Imaging (MRI) and MRI-Targeted Biopsy for Active Surveillance

This review explores the role of magnetic resonance imaging (MRI) and MRI-targeted biopsies in the selection and monitoring of men with low-risk prostate cancer (PCa) who are on active surveillance (AS). At present, MRI and MRI-targeted biopsies are broadly recommended for the selection and monitoring of men with low-risk PCa on AS. Multiparametric MRI (mpMRI) and MRI-targeted biopsies should be considered for screening, or in the early period following screening, for men who have been enrolled after only a random transrectal ultrasound-guided biopsy in order to reduce initial misclassification. However, a significant number of pathological progressions were diagnosed solely by systematic biopsies. This suggests that systematic biopsy, in conjunction with MRI-targeted biopsy and protocol-based transrectal ultrasound-guided biopsy, should not be omitted when there are no visible lesions on mpMRI. The use of MRI features during AS, particularly the PRECISE (Prostate Cancer Radiological Estimation of Change in Sequential Evaluation) score, appears promising as it offers a more accurate risk restratification during follow-up. Evidence for these changes is awaited from larger, prospective cohorts.