The Role of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Biopsy in Active Surveillance

Progression and treatment rates using an active surveillance protocol incorporating image‐guided baseline biopsies and multiparametric magnetic resonance imaging monitoring for men with favourable‐risk prostate cancer

“…Nearly a third of pathological progressions were detected by scheduled protocol biopsies without evidence of an mpMRI or PSA change. This echoes the recent findings of Ma et al [29] from Johns Hopkins who reviewed the results of 157 men who had template and systematic biopsies within an AS programme, and concluded that systematic re-biopsies were still needed in AS given the relatively low sensitivity of mpMRI in this context. Further work is needed in larger multicentre trials to determine the true benefit and impact of mpMRI use in AS pathways before widespread adoption in national guidelines.…”

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

“…However, they showed that in patients with a negative mpMRI, sysPbx still resulted in a 9% upgrading to Gleason score ≥4 + 3 and concluded that sysPbx should still be offered even with prior extended sextant biopsy [31]. Other data confirm this by showing a low relative sensitivity ratio of 0.33 for the detection of Gleason score ≥7 PCa in mpMRI compared to sysPbx [32]. In contrast, other study groups demonstrated that mpMRI and targeted biopsy mainly contributed to the Gleason score upgrading, whereas sysPbx did not lead to an upgrading [33].…”

How can we expand active surveillance criteria in patients with low‐ and intermediate‐risk prostate cancer without increasing the risk of misclassification? Development of a novel risk calculator

“…For example, previous studies have suggested that patients eligible for AS according to the PRIAS criteria with visible lesions at mpMRI were more likely to experience upgrading at RP as compared to their counterparts with a negative mpMRI . On the other hand, other authors have failed to show an advantage associated with mpMRI‐targeted biopsies as compared to the standard random approach in AS candidates . Unfortunately, the evaluation of a large cohort of patients treated over a long period precluded us from comparing the accuracy of mpMRI and the novel risk calculator in predicting the risk of misclassification.…”