The role of MRI in active surveillance of prostate cancer

Purpose of review The aim of active surveillance is to avoid radical treatment and its side-effects in men who have truly low risk prostate cancer, whilst offering radical treatment to those men who are at higher risk of local progression or metastatic disease. The traditional tools used to attribute these risk categories are prostate specific antigen, digital rectal examination, transrectal biopsy and their repeated application over time. MRI is emerging as a tool which may be able to more accurately determine the risk of significant disease at diagnosis and progression of disease over time. This review will examine the role of MRI in men on active surveillance. Recent findings The body of work on MRI as a tool for the detection of significant cancer is rapidly increasing, both in men undergoing initial assessment for prostate cancer risk, and in those who have low risk cancer on standard transrectal ultrasound guided biopsy. In addition, the use of MRI as a tool to detect change in prostate cancer is being explored by a small number of groups. Summary Multiparametric MRI is a useful tool in the initial assessment and surveillance of men who choose to avoid radical treatment when first diagnosed with localized prostate cancer.