Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance for low-risk prostate cancer: a scoping review on the benefits and harm of mpMRI in different biopsy scenarios

Prostate Cancer and Prostatic Diseases volume 24, pages 662–673 (2021)Cite this article

Subjects

Abstract

Background

There is uncertainty on how multiparametric MRI (mpMRI) and MRI-targeted biopsy (MRI-TB) can be best used to manage low-risk prostate cancer patients on Active Surveillance (AS). We performed a scoping review to evaluate the benefits and harm associated with four different biopsy scenarios in which mpMRI can be implemented in AS.

Methods

Medline, Embase and Cochrane Library databases (1 January 2013–18 September 2020) were searched. Included studies were on men with low-risk prostate cancer enrolled in AS, who had mpMRI ± MRI-TB and standard prostate biopsy (systematic transrectal ultrasound or transperineal saturation biopsy), at confirmatory or follow-up biopsy. Primary outcomes were the number of Gleason score upgrades and biopsies avoided.

Results

Eight confirmatory biopsy studies and three follow-up biopsy studies were included. Compared to the benchmark of using standard biopsy (SB) for all men, the addition of MRI-TB increased the detection of Gleason score upgrades at both confirmatory (6/8 studies) and follow-up biopsy (3/3 studies), with increments of 1.7–11.8 upgrades per 100 men. 6/7 studies suggested that the use of a positive mpMRI to triage men for MRI-TB or SB alone would detect fewer Gleason score upgrades than benchmark at confirmatory biopsy, but the combination of MRI-TB and SB would detect more upgrades than the benchmark. For follow-up biopsy, the evidence on mpMRI triage biopsy scenarios was inconclusive due to the small number of included studies.

Conclusions

The addition of MRI-TB to benchmark (SB for all men) maximises the detection of Gleason score upgrades at confirmatory and follow-up biopsy. When the use of mpMRI to triage men for a biopsy is desired, the combination of MRI-TB and SB should be considered for men with positive mpMRI at confirmatory biopsy. The evidence on mpMRI triage scenarios was inconclusive in the follow-up biopsy setting.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: PRISMA flow diagram showing study selection process.
Fig. 2: Summary of Gleason score upgrade rates relative to the benchmark.

Similar content being viewed by others

References

  1. Mottet N, Bellmunt J, Briers E, Bolla M, Bourke L, Cornford P, et al. members of the EAU – ESTRO – ESUR –SIOG Prostate Cancer Guidelines Panel. EAU – ESTRO – ESUR – SIOG Guidelines on Prostate Cancer. Chapter 5 Diagnostic evaluation. 2020. Retrieved from: https://uroweb.org/guideline/prostate-cancer/. Accessed 1 Aug 2020.

  2. National Insititute for Health and Care Excellence [NICE]. Prostate cancer: diagnosis and management (Guideline 131), 2019.

  3. (NCCN) NCCN. Prostate Cancer (Version 2.2019), 2019.

  4. Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A, et al. Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a randomized prospective study in biopsy-naive patients with suspected prostate cancer. Eur Urol. 2017;72:282–8.

    Article  Google Scholar 

  5. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389:815–22.

    Article  Google Scholar 

  6. Drost FH, Osses D, Nieboer D, Bangma CH, Steyerberg EW, Roobol MJ, et al. Prostate magnetic resonance imaging, with or without magnetic resonance imaging-targeted biopsy, and systematic biopsy for detecting prostate cancer: a cochrane systematic review and meta-analysis. Eur Urol. 2019;77:78–94.

    Article  Google Scholar 

  7. van der Leest M, Cornel E, Israel B, Hendriks R, Padhani AR, Hoogenboom M, et al. Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naive Men with Elevated Prostate-specific Antigen: A Large Prospective Multicenter Clinical Study. Eur Urol. 2019;75:570–8.

    Article  Google Scholar 

  8. Rouviere O, Puech P, Renard-Penna R, Claudon M, Roy C, Mege-Lechevallier F, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019;20:100–9.

    Article  Google Scholar 

  9. Sathianathen NJ, Butaney M, Bongiorno C, Konety BR, Bolton DM, Lawrentschuk N. Accuracy of the magnetic resonance imaging pathway in the detection of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2018;22:39–48.

    Article  Google Scholar 

  10. Schoots IG, Nieboer D, Giganti F, Moore CM, Bangma CH, Roobol MJ. Is magnetic resonance imaging-targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low-risk prostate cancer? A systematic review and meta-analysis. BJU Int. 2018;122:946–58.

    Article  Google Scholar 

  11. Moore CM, Kasivisvanathan V, Eggener S, Emberton M, Futterer JJ, Gill IS, et al. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol. 2013;64:544–52.

    Article  Google Scholar 

  12. Hu JC, Chang E, Natarajan S, Margolis DJ, Macairan M, Lieu P, et al. Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply? J Urol. 2014;192:385–90.

    Article  Google Scholar 

  13. Alberts AR, Roobol MJ, Drost FH, van Leenders GJ, Bokhorst LP, Bangma CH, et al. Risk-stratification based on magnetic resonance imaging and prostate-specific antigen density may reduce unnecessary follow-up biopsy procedures in men on active surveillance for low-risk prostate cancer. BJU Int. 2017;120:511–9.

    Article  CAS  Google Scholar 

  14. Hoeks CM, Somford DM, van Oort IM, Vergunst H, Oddens JR, Smits GA, et al. Value of 3-T multiparametric magnetic resonance imaging and magnetic resonance-guided biopsy for early risk restratification in active surveillance of low-risk prostate cancer: a prospective multicenter cohort study. Invest Radio. 2014;49:165–72.

    Article  Google Scholar 

  15. Hamoen EHJ, Hoeks CMA, Somford DM, van Oort IM, Vergunst H, Oddens JR, et al. Value of serial multiparametric magnetic resonance imaging and magnetic resonance imaging-guided biopsies in men with low-risk prostate cancer on active surveillance after 1 yr follow-up. Eur Urol Focus. 2018;5:407–15.

    Article  Google Scholar 

  16. Osses DF, Drost FH, Verbeek JFM, Luiting HB, van Leenders G, Bangma CH, et al. Prostate cancer upgrading with serial prostate magnetic resonance imaging and repeat biopsy in men on active surveillance: are confirmatory biopsies still necessary? BJU Int. 2020;126:124–32.

    Article  Google Scholar 

  17. Filson CP, Natarajan S, Margolis DJ, Huang J, Lieu P, Dorey FJ, et al. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies. Cancer. 2016;122:884–92.

    Article  Google Scholar 

  18. Pepe P, Cimino S, Garufi A, Priolo G, Russo GI, Giardina R, et al. Detection rate for significant cancer at confirmatory biopsy in men enrolled in Active Surveillance protocol: 20 cores vs 30 cores vs MRI/TRUS fusion prostate biopsy. Arch Ital Urol Androl. 2016;88:300–3.

    Article  Google Scholar 

  19. Pepe P, Garufi A, Priolo G, Pennisi M. Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance? World J Urol. 2016;34:1249–53.

    Article  Google Scholar 

  20. Da Rosa MR, Milot L, Sugar L, Vesprini D, Chung H, Loblaw A, et al. A prospective comparison of MRI-US fused targeted biopsy versus systematic ultrasound-guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance. J Magn Reson Imaging. 2015;41:220–5.

    Article  Google Scholar 

  21. Ma TM, Tosoian JJ, Schaeffer EM, Landis P, Wolf S, Macura KJ, et al. The role of multiparametric magnetic resonance imaging/ultrasound fusion biopsy in active surveillance. Eur Urol. 2017;71:174–80.

    Article  Google Scholar 

  22. Klotz L, Loblaw A, Sugar L, Moussa M, Berman DM, Van der Kwast T, et al. Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial. Eur Urol. 2018;75:300–9.

    Article  Google Scholar 

  23. Chen K, Tay KJ, Law YM, Aydin H, Ho H, Cheng C, et al. Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance. Asian J Urol. 2018;5:184–93.

    Article  CAS  Google Scholar 

  24. Thurtle D, Barrett T, Thankappan-Nair V, Koo B, Warren A, Kastner C, et al. 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. BJU Int. 2018;122:59–65.

    Article  CAS  Google Scholar 

  25. Barzell WE, Melamed MR, Cathcart P, Moore CM, Ahmed HU, Emberton M. Identifying candidates for active surveillance: an evaluation of the repeat biopsy strategy for men with favorable risk prostate cancer. J Urol. 2012;188:762–7.

    Article  Google Scholar 

  26. Feng TS, Sharif-Afshar AR, Smith SC, Miller J, Nguyen C, Li Q, et al. Multiparametric magnetic resonance imaging localizes established extracapsular extension of prostate cancer. Urol Oncol. 2015;33:109 e115–22.

    Article  Google Scholar 

  27. Pessoa RR, Viana PC, Mattedi RL, Guglielmetti GB, Cordeiro MD, Coelho RF, et al. Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance. BJU Int. 2017;119:535–42.

    Article  CAS  Google Scholar 

  28. Klotz L, Pond G, Loblaw A, Sugar L, Moussa M, Berman D, et al. Randomized study of systematic biopsy versus magnetic resonance imaging and targeted and systematic biopsy in men on active surveillance (ASIST): 2-year postbiopsy follow-up. Eur Urol. 2020;77:311–7.

    Article  Google Scholar 

  29. Giganti F, Pecoraro M, Stavrinides V, Stabile A, Cipollari S, Sciarra A, et al. Interobserver reproducibility of the PRECISE scoring system for prostate MRI on active surveillance: results from a two-centre pilot study. Eur Radiol. 2020;30:2082–90.

    Article  Google Scholar 

  30. Moore CM, Giganti F, Albertsen P, Allen C, Bangma C, Briganti A, et al. Reporting magnetic resonance imaging in men on active surveillance for prostate cancer: the PRECISE recommendations-a report of a European school of oncology task force. Eur Urol. 2017;71:648–55.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Karen Chiam, Chelsea Carle

Authors and Affiliations

  1. Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia

    Karen Chiam, Chelsea Carle, Suzanne Hughes & David P. Smith

  2. School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Karen Chiam, Chelsea Carle, Suzanne Hughes & David P. Smith

  3. Department of Tissue Pathology, Royal Prince Alfred Hospital, NSW Health Pathology, Camperdown, NSW, Australia

    James G. Kench

  4. School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    James G. Kench

  5. Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW, Australia

    Henry H. Woo

  6. Department of Uro-oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia

    Henry H. Woo

  7. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

    Sally Lord

  8. School of Medicine, University of Notre Dame of Australia, Sydney, NSW, Australia

    Sally Lord

Authors
  1. Karen Chiam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chelsea Carle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suzanne Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James G. Kench
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henry H. Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sally Lord
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David P. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen Chiam.

Ethics declarations

Conflict of interest

The authors declare no conflict of interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiam, K., Carle, C., Hughes, S. et al. Use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance for low-risk prostate cancer: a scoping review on the benefits and harm of mpMRI in different biopsy scenarios. Prostate Cancer Prostatic Dis 24, 662–673 (2021). https://doi.org/10.1038/s41391-021-00320-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-021-00320-9

This article is cited by

Search

Advanced search

Quick links