MRI is significantly affecting how we manage patients on Active Surveillance for Prostate Cancer
- Manuel S. Eisenberg
- Jun 8
- 2 min read
TL;DR: MRI is helping us identify patients safe to start on active surveillance and may help reduce unneeded prostate biopsies in the future.
Active Surveillance was introduced in the 1990s as a way to monitor men with low-risk prostate cancer (PCa) while deferring immediate treatment. Initially limited to men with “insignificant” cancers under strict criteria, active surveillance has since expanded to include low and some intermediate-risk patients, reflecting updated understanding and safety data. Today, with 1 in 8 American men developing PCa and most diagnosed with low/intermediate-risk disease, active surveillance has become a vital component of PCa management.
In a contemporary active surveillance program, 869 men were enrolled and followed using two newer tools: MRI-guided biopsy and focal therapy (FT). MRI-guided biopsy improves diagnostic accuracy and is now standard in many active surveillance programs.
Over a median follow-up of 4.1 years (2.1–6.8), 2374 MRI-guided biopsies were performed. Follow-up data showed that MRI-guided biopsy can predict outcomes from the outset and potentially reduce the need for routine repeat biopsies, especially when MRI findings remain negative. Among 664 men monitored for over a year, 132 progressed to higher-grade cancers (Grade Group 3 or greater), with many upgrades detected only by advanced techniques like tracking biopsy.
The use of MRI-guided biopsy enhanced active surveillance outcomes by:
Improving baseline risk stratification.
Reducing unnecessary follow-up biopsies.
Minimizing anxiety-driven treatment decisions.
Potentially increasing the duration men remain safely on active surveillance.
Additionally, MRI-guided biopsy helped guide biopsy site tracking, which proved valuable in detecting upgrades. The study also noted that anxiety events (patients choosing treatment despite no disease progression) decreased over time, possibly due to greater confidence in active surveillance supported by MRI-guided biopsy and better symptom management.
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