Can MRI replace serial biopsies in men on active surveillance for prostate cancer?

Purpose of review The role of MRI in active surveillance to date has been in assessing men with low or intermediate-risk disease to identify those men harbouring higher risk disease undersampled at standard biopsy. MRI as a tool for reassessing men over the surveillance period, as an alternative to repeat standard biopsies, is also of interest. Recent findings Multiple studies suggest that MRI early in active surveillance can identify men whose prostate cancer was undersampled at initial biopsy, and MRI-targeted biopsies can be offered. There are a small number of centres now using MRI in the routine follow-up of men on active surveillance. The presence of a lesion on MRI indicates that a man is at higher likelihood of radiological progression than men with a negative MRI at diagnosis. These findings need to be validated in longer-term studies with predefined criteria for radiological significance and radiological progression. Summary MRI is useful in the identification of men with higher-risk prostate cancer prior to commencement of a formal active surveillance programme. It is also of use in following up men on active surveillance, as a way to detect change in tumour over time.