Accurate Active Surveillance with mpMRI
Active Surveillance with Multi-Parametric Magnetic Resonance Imaging
Multi-parametric magnetic resonance imaging (mpMRI) is used in prostate cancer screening to detect and localize prostate cancer, as well as to help determine prognosis and appropriate disease management. In some cases, mpMRI can rule out prostate cancer, avoiding the need for a prostate biopsy. It is estimated that mpMRI can increase the detection of clinically significant disease over other methods by 50% and reduce the number of unnecessary biopsies by one-third.
For men with slower-growing cancers, mpMRI allows for more confident active surveillance or watchful waiting.
ACTIVE SURVEILLANCE (AS) is appropriate for younger men with low risk cancer who wish to postpone or avoid definitive treatment, or older men for whom the cancer may never cause a problem. Typically, patients will have a DRE and PSA every 3 – 6 months and a biopsy once a year.
WATCHFUL WAITING (WW) is for men who have low risk cancer and a life expectancy of less than 10 years or have a history of serious health problems that may make some treatments too risky. Typically, patients will have a DRE and PSA test every 6 – 12 months. Hormone therapy may be used if the cancer begins to spread and the patient becomes symptomatic.
Benefits of mpMRI for Assisting in Watchful Waiting and Active Surveillance
- mpMRI’s are non-invasive. Patients who elect Watchful Waiting or Active Surveillance can get a baseline study performed to make sure they are truly a good candidate for expectant management.
- While in Active Surveillance or Watchful Waiting , the Multiparametric MRI can be repeated if there is a change in the DRE or PSA to determine if there is a higher risk of progression of the prostate cancer.
- MRI-guided biopsies can ensure that the Gleason Score is accurate so that patients may be correctly directed to Watchful Waiting / Active Surveillance or definitive treatment.
Men diagnosed with aggressive cancers can have an mpMRI-guided biopsy, which provides more accurate results that can reduce time-to-treatment. mpMRI can then be used to monitor the effects of the treatment to guide decision-making.
mpMRI-Guided Biopsy with Active Surveillance
Men on Active Surveillance may not need an immediate TRUS biopsy if their PSA starts to rise. The way to overcome the shortcomings of conventional PSA/biopsy monitoring is an mpMRI of the prostate. This is the best way to conduct prostate imaging – showing the size, shape, location and aggression level of prostate cancer.
If a suspicious area is found on the multi-parametric MRI scan, we can perform an MRI-guided biopsy that is targeted to the suspicious area. A targeted mpMRI-guided biopsy provides greater accuracy in diagnosis with fewer needle cores than traditional ultrasound guided approach, resulting in less pain and a lower risk of infection.
Updated AUA Policy Statement
While only a biopsy can diagnose cancer, mpMRI imaging with a multi-parametric approach can assist with the characterization of areas within the gland that may warrant biopsy. Given the utility of mpMRI, the AUA recommends an MRI for men with abnormal PSA and BEFORE biopsy.
Learn More About the AUA Policy Statement: Update of the Standard Operating Procedure on the Use of Multiparametric Magnetic Resonance Imaging for the Diagnosis, Staging and Management of Prostate Cancer