Platinum Priority – Review – Prostate CancerEditorial by Chris H. Bangma, Riccardo Valdagni, Peter R. Carroll, Hein van Poppel, Laurence Klotz and Jonas Hugosson on pp. 646–648 of this issueMagnetic Resonance Imaging in Active Surveillance of Prostate Cancer: A Systematic Review
Introduction
There is growing interest in the use of magnetic resonance imaging (MRI) in active surveillance for prostate cancer for both determining initial eligibility and assessing changes over time. The most recent UK National Institute for Health and Care Excellence (NICE) recommendations [1] stipulate that MRI should be performed after an initial decision for active surveillance to detect more aggressive disease not detected at routine biopsy. A second biopsy is recommended at 12 mo, and then further assessment in response to changes in digital rectal examination or adverse prostate-specific antigen (PSA) kinetics can be made via MRI or biopsy.
In this review we systematically assessed evidence for the use of MRI in men with low- or intermediate risk prostate cancer on transrectal ultrasound-guided biopsy and suitable for active surveillance. We sought to address two clinical questions in this population. (1) Can MRI detect clinically significant disease in men on active surveillance? (2) Can MRI be used in place of repeat standard biopsy to detect progression over time?
Section snippets
Evidence acquisition
The Ovid Medline and Embase databases were searched from inception (1946 for Ovid Medline, 1974 for Embase) until April 25, 2014. The search terms used were (active surveillance OR surveillance OR active monitoring) AND (prostate cancer OR prostate adenocarcinoma OR prostate carcinoma OR prostatic carcinoma OR prostatic adenocarcinoma) AND (MRI OR NMR OR magnetic resonance imaging OR mpMRI OR multiparametric MRI).
Abstracts were reviewed independently by four of the authors (IS, LPB, FG, NP) to
Evidence synthesis
We used evidence synthesis across the full papers to answer our two clinically relevant questions. We address each question in turn.
Conclusions
We analysed the first published studies on MRI and active surveillance in men with low or intermediate risk of prostate cancer. The evidence and strength are limited by the relatively small number of studies, as well as the lack of standardisation within those studies. However, it is evident that MRI is positive in roughly two-thirds of men suitable for active surveillance, and that MRI-targeted biopsies or radical prostatectomy histopathology results in reclassification in 1:2–3 men. It should
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