Active Surveillance of Prostate Cancer Using Multiparametric Magnetic Resonance Imaging: A Review of the Current Role and Future Perspectives

Abstract

Departmental sourcesClinically, active surveillance involves continuous monitoring of patients who may be at risk for disease. Patients with low-grade and early-stage prostate cancer may benefit from active surveillance, rather than undergoing surgical and medical treatments that are associated with side effects. In these cases, the role of active surveillance is to ensure that there is no progression of the disease. However, active surveillance may be associated with a risk of under-diagnosis. Previously, the assignment of risk categories and patient monitoring were based on digital rectal examination, transrectal prostate biopsy, and monitoring of serum levels of prostatespecific antigen (PSA). Multiparametric magnetic resonance imaging (MRI) of the prostate gland has an estimated negative predictive value of 95% for the detection of prostate cancer, which makes this an effective imaging method for targeting biopsies and for monitoring patients over time. Also, multiparametric MRI-guided biopsy at the initial stage of the risk stratification for patients who are newly diagnosed with prostate cancer may reduce the number of underdiagnosed patients, improve long-term patient prognosis, and reduce the number of patients who are overtreated, which may reduce healthcare costs and reduce treatment morbidity. For these reasons, multiparametric MRI has become an accepted monitoring tool in patients who are enrolled in active surveillance programs. This review aims to present the current status of the use of multiparametric MRI in active surveillance of prostate cancer and to discuss future perspectives, supported by recent literature.

PLK1 downregulation by RO3280 prevents cell proliferation, migration, and invasion via the Wnt/β-catenin pathway in prostate cancer

“…A previously published study reported that RO3280 exerts antitumor effects, facilitated predominantly by DNA damage, cell cycle arrest, and apoptosis in breast cancer cells [2]. In our previous study too, we found that RO3280 repressed bladder carcinoma growth through G2/M arrest and mitotic arrest [6].…”

“…Prostate cancer is among the most pernicious tumors of the genitourinary system and is the second most commonly observed cause of cancer-related death among men in Western countries [1]. The diverse clinical behaviors of prostate cancer include a sloth-like characteristic with little or no clinical value, invasive metastasis, and lethality [2,3].…”

Diagnosis of Prostate Cancer in Patients with Prostate-Specific Antigen (PSA) in the Gray Area: Construction of 2 Predictive Models

“…Selvi et al reported that arginine and its metabolites, including plasma arginine, ornithine, arginine to ornithine ratio, and urinary diacetylspermine, could be used as molecular markers to predict PCa when the PSA level is in the gray area, and these biomarkers could be an important research focus in diagnosing PCa [ 40 ]. Third, active surveillance (AS), a strategy of management of patients with low-risk prostate cancer, could reduce unnecessary over-treatment [ 41 ]. A meta-analysis found the mpMRI-targeted biopsy is a useful addition to systematic confirmation in patients on AS with low-risk PCa [ 42 ].…”

Prostate cancer biomarkers and multiparametric MRI: is there a role for both in prostate cancer management?

“…However, most (82.6%) of the MRI-invisible lesions from the study were low risk based on Decipher testing, suggesting the addition of Decipher to MRI may not yield significantly more detection of CS cancer. 48 …”