For Men on Active Surveillance, MRIs Alone Are Not Enough

Categories: Winter 2020

MRI technology has not advanced enough for men with low-risk prostate cancer on active surveillance to forgo routine surveillance biopsies.

While on active surveillance, men must have regular monitoring to make sure their disease has not progressed to the point where active treatment, such as surgery or radiation, would be necessary. Active surveillance monitoring generally includes routine PSA testing and prostate biopsies every 1-3 years, depending upon the findings. Research is currently exploring what role MRI scans should have in active surveillance, as they are non-invasive.

Multiparametric magnetic resonance imaging (mpMRI) is a newer type of MRI scan that makes a 3-D picture of the prostate. These scans can find a “target” area within the prostate that is suspicious for prostate cancer. The use of mpMRI scans before a prostate biopsy had made it easier to detect prostate cancer.

However, a new study suggests that mpMRIs are not accurate enough to identify disease progression for men on active surveillance. The research found that mpMRI scans missed a significant number—21.5%—of cancers that had progressed. The mpMRI scans for these men came back as negative, indicating the cancer was still low-risk, but their prostate biopsies revealed the disease had actually gotten worse. For men with higher PSA densities, the scans missed an even greater percentage of significant disease progression.

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