Imaging technology can be used in active surveillance to monitor prostate cancer

The authors aimed to determine how effective magnetic resonance imaging is in monitoring patients with prostate cancer undergoing active surveillance.

Active surveillance is used in patients with favorable-risk prostate cancer (very low or low risk – cancer cannot be felt or seen by imaging or is localised to the prostate). Under active surveillance the patient does not receive active treatment. Instead the cancer is closely monitored and frequent check-ups are undertaken to detect any cancer progression. This is usually carried out using biopsy (tissue sample taken from the prostate that is examined to determine cancer stage or progression).

Magnetic resonance imaging (MRI) is a non-invasive imaging test that provides detailed images of the body that help doctors in diagnosing and treating a disease. Multiparametric prostate MRI (MP MRI) is a new technique used to diagnose cancer in the prostate, reducing the risk of over-treatment and under-staging in men with prostate cancer.

The aim of this article was to evaluate MR imaging and the ability to detect prostate cancer in patients undergoing active surveillance.

96 patients were used in this study. 75 patients (78.1%) remained on active surveillance while 21 patients received active treatments (surgery or radiation).

Of the 96 patients, 12 (12.5%) had  MR-invisible tumors (tumors that could not be detected using MR imaging technology). Of these, one patient (8.3%) had adverse biopsy results indicating that cancer may have progressed compared to 40.5% (34/84) of patients with MR-visible tumors (tumors that can be seen using MR imaging technology).

Patients with MR-invisible tumors had a 65% reduction in the odds of experiencing biopsy results indicating cancer may have progressed compared to patients with MR-visible tumors. The risk of experiencing biopsy results indicating cancer may have progressed was reduced by 89% in MR-invisible patients when prostate specific antigen (PSA – protein elevated in the blood when prostate cancer is present) levels were included compared to MR-visible patients.

The authors conclude that MR imaging can be used to monitor men with MR-invisible tumors to prevent over-treatment and improve cancer monitoring during active surveillance and that patients with MR-invisible tumors are at a lower risk of experiencing biopsy results indicating that cancer has progressed.

The short follow-up time in patients with MR-invisible tumors may have led to a more favorable outcome and results may be inaccurate when applied in a large population.

Please consult your doctor if you are currently undergoing active surveillance and have queries regarding magnetic resonance imaging in monitoring prostate cancer progression.