Can men with low-risk prostate cancer on active surveillance be monitored only by PSA and MRI?

This study aimed to investigate if MRI scans (a test that takes detailed images of inside the body) could safely replace biopsies (samples taken from tissues for close examination) in active surveillance for prostate cancer. This study found that men with low-risk disease can be monitored using MRI and PSA levels with selective biopsy.

Active surveillance (AS) is often recommended in early-stage prostate cancer instead of active treatment. This involves monitoring the prostate for any changes by regular testing. This monitoring can be done using magnetic resonance imaging (MRI), the prostate-specific antigen (PSA; a substance produced by the prostate) as a marker and doing regular biopsies of the prostate. 

All active surveillance programmes do an initial biopsy, MRI and PSA. There is evidence that regular biopsies can be replaced by a monitoring program of repeat MRI scans and PSA testing, and only using biopsies if those tests give 'high risk' results (selective biopsy). It is unclear if active surveillance can be carried out using MRI and PSA measurement.

This study included 211 patients with early-stage prostate cancer. After the initial biopsy, they were monitored using PSA measurements and repeat MRI scans. They were followed up for an average of 4.2 years.

During the follow-up period, 27.5% of patients had progressed to need more active treatment. Men with high-risk visible tumors on their original MRI had a higher risk of cancer progression (25%) compared to men who had no visible tumor on the first MRI scan (10.7%). There was a higher chance of men progressing to cancer treatment is they had a visible tumor in their first MRI scan. 

A rise in PSA levels was also associated with cancer progression in men with no visible tumor on the first MRI scans.

The risk of cancer progression in men with no visible tumors on the first MRI scan was similar for those who had a biopsy (12.5%) and those who did not (13.3%).

This study found that men with low-risk prostate cancer on active surveillance can go without regular biopsies and be monitored using MRI scans and PSA measurements.

Discuss with your doctor any concerns you may have regarding active surveillance monitoring.