The role of mpMRI for low and intermediate risk prostate cancer during active surveillance

The widespread use of prostate-specific antigen (PSA) as a screening test has led to a decrease in cancer-related mortality but also to an increased detection of patients with low risk prostate cancer at biopsy. Risk stratification for prostate cancer is based on different parameters such as clinical stage, PSA, Gleason score at biopsy and an estimate of cancer volume.

Active surveillance (AS) has been increasingly adopted as a management option in patients with low and intermediate risk prostate cancer and a life expectancy of more than 10 years. The aim of AS is to avoid treatment-related side effects while preserving oncological efficacy by offering appropriate treatment when there is evidence of higher risk disease. Although patients managed with AS have shown excellent outcomes, with a cancer-specific survival of 100%, it has been reported that more than a third of patients on AS are likely to undergo curative intervention due to (or because of) disease upgrading at subsequent biopsy.

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