The performance of multiparametric magnetic resonance imaging (mpMRI) and subsequent biopsy in monitoring prostate cancer in men on active surveillance (AS) have not been defined clearly. In this systematic review, we aimed to review current literature about the usage of MRI examination in men with low-risk prostate cancer during active surveillance. For that, we searched seven databases to include all studies reporting magnetic resonance imaging in the AS of low-risk prostate cancer. We finally included 11 studies with 1237 patients included. Our results showed an adequate sensitivity and specificity of both modalities to detect disease progression; including disease upgrading and upstaging. However, the performance in the prediction of unfavorable disease was inferior to the detection of upgrading and upstaging. In terms of MRGB, the previous literature agreed on the superiority of using a combination of different biopsy schemes to get a better progression section. Noteworthy, mp-MRI and MRGB had a good predictive value limited to the first year, with TRUSGB showing a superior role in detecting patients with a GS ≥ 7, after that. In conclusion, both of mpMRI and MRGB have shown an adequate performance on assessing disease progression in the AS of low-risk prostate cancer patients. They can be used for disease staging and grading for successful treatment planning.