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Multiparametric magnetic resonance imaging in the active surveillance of prostate cancer: protocol, risk stratification, and surveillance

  • Xiaoyan Qin1
  • Jian Lv1
  • Xiqi Zhu1,*,

1Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541002 Guilin, Guangxi Zhuang Autonomous Region, China

DOI: 10.22514/jomh.2024.050 Vol.20,Issue 4,April 2024 pp.12-18

Submitted: 17 October 2023 Accepted: 27 November 2023

Published: 30 April 2024

*Corresponding Author(s): Xiqi Zhu E-mail:


Active surveillance serves as a vital management strategy for patients diagnosed with low-risk, organ-confined prostate cancer and is aimed at reducing overtreatment, cost minimization and enhancing patients’ quality of life. However, the comprehensive implementation of active surveillance faces various challenges necessitating improvement, such as refining screening criteria, optimizing surveillance procedures, and establishing clear guidelines for active intervention. Multiparametric magnetic resonance imaging (mp-MRI) has assumed an increasingly pivotal role in the context of active surveillance. It provides essential supplementary insights into the identification and characteristics of prostate cancer. mp-MRI improves the precision of risk stratification, thus enhancing patient selection and compliance. Furthermore, it facilitates continuous disease monitoring, thereby reducing the probability of missed treatment opportunities during follow-up. This review, characterized by its meticulous analysis, aims to comprehensively examine the utilization and advancements of mp-MRI in the active surveillance of prostate cancer.


Prostate cancer; Active surveillance; Multiparametric magnetic resonance imaging; Risk stratification

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Xiaoyan Qin,Jian Lv,Xiqi Zhu. Multiparametric magnetic resonance imaging in the active surveillance of prostate cancer: protocol, risk stratification, and surveillance. Journal of Men's Health. 2024. 20(4);12-18.


[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[2] Liu JL, Patel HD, Haney NM, Epstein JI, Partin AW. Advances in the selection of patients with prostate cancer for active surveillance. Nature Reviews Urology. 2021; 18: 197–208.

[3] Silva Gaspar SR, Fernandes M, Castro A, Oliveira T, Santos Dias J, Palma dos Reis J. Active surveillance protocol in prostate cancer in Portugal. Actas UrolóGicas EspañOlas. 2022; 46: 329–339.

[4] Wilt TJ, Ullman KE, Linskens EJ, MacDonald R, Brasure M, Ester E, et al. Therapies for clinically localized prostate cancer: a comparative effectiveness review. Journal of Urology. 2021; 205: 967–976.

[5] de Vos II, Luiting HB, Roobol MJ. Active surveillance for prostate cancer: past, current, and future trends. Journal of Personalized Medicine. 2023; 13: 629.

[6] Pattenden TA, Samaranayke D, Morton A, Ong WL, Murphy DG, Pritchard E, et al. Modern active surveillance in prostate cancer: a narrative review. Clinical Genitourinary Cancer. 2023; 21: 115–123.

[7] Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, et al. Literature review: imaging in prostate cancer. Current Problems in Cancer. 2023; 47: 100968.

[8] Handke AE, Ritter M, Albers P, Noldus J, Radtke JP, Krausewitz P. Prostate cancer—multiparametric MRI and alternative approaches in intervention and therapy planning. Die Urologie. 2023; 62: 1160–1168.

[9] Chamorro Castillo L, García Morales L, Ruiz López D, Salguero Segura J, Valero Rosa J, Anglada Curado F, et al. The role of multiparametric magnetic resonance in active surveillance of a low-risk prostate cancer cohort from clinical practice. The Prostate. 2023; 83: 765–772.

[10] Leith A, Kim J, Ribbands A, Clayton E, Yang L, Ghate SR. Real-world treatment patterns in metastatic castration-resistant prostate cancer across Europe (France, Germany, Italy, Spain, and the United Kingdom) and Japan. Advances in Therapy. 2022; 39: 2236–2255.

[11] Huang J, Chan EO, Liu X, Lok V, Ngai CH, Zhang L, et al. Global trends of prostate cancer by age, and their associations with gross domestic product (GDP), human development index (HDI), smoking, and alcohol drinking. Clinical Genitourinary Cancer. 2023; 21: e261–e270.e50.

[12] Qiu H, Cao S, Xu R. Cancer incidence, mortality, and burden in China: a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020. Cancer Communications. 2021; 41: 1037–1048.

[13] Zhu Y, Mo M, Wei Y, Wu J, Pan J, Freedland SJ, et al. Epidemiology and genomics of prostate cancer in Asian men. Nature Reviews Urology. 2021; 18: 282–301.

[14] Auffenberg GB, Lane BR, Linsell S, Cher ML, Miller DC. Practice- vs physician-level variation in use of active surveillance for men with low-risk prostate cancer: implications for collaborative quality improvement. JAMA Surgery. 2017; 152: 978–980.

[15] Mahal BA, Butler S, Franco I, Spratt DE, Rebbeck TR, D’Amico AV, et al. Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United States, 2010–2015. JAMA. 2019; 321: 704–706.

[16] Cooperberg MR, Carroll PR. Trends in management for patients with localized prostate cancer, 1990–2013. JAMA. 2015; 314: 80–82.

[17] Loeb S, Folkvaljon Y, Curnyn C, Robinson D, Bratt O, Stattin P. Uptake of active surveillance for very-low-risk prostate cancer in Sweden. JAMA Oncology. 2017; 3: 1393–1398.

[18] Weerakoon M, Papa N, Lawrentschuk N, Evans S, Millar J, Frydenberg M, et al. The current use of active surveillance in an Australian cohort of men: a pattern of care analysis from the Victorian prostate cancer registry. BJU International. 2015; 115: 50–56.

[19] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018; 68: 394–424.

[20] Zhang K, Bangma CH, Roobol MJ. Prostate cancer screening in Europe and Asia. Asian Journal of Urology. 2017; 4: 86–95.

[21] Tosoian JJ, JohnBull E, Trock BJ, Landis P, Epstein JI, Partin AW, et al. Pathological outcomes in men with low risk and very low risk prostate cancer: implications on the practice of active surveillance. Journal of Urology. 2013; 190: 1218–1223.

[22] Parker PA, Davis JW, Latini DM, Baum G, Wang X, Ward JF, et al. Relationship between illness uncertainty, anxiety, fear of progression and quality of life in men with favourable-risk prostate cancer undergoing active surveillance. BJU International. 2016; 117: 469–477.

[23] Albertsen PC. PSA testing, cancer treatment, and prostate cancer mortality reduction: what is the mechanism? Urologic Oncology. 2023; 41: 78–81.

[24] Bass EJ, Pantovic A, Connor MJ, Loeb S, Rastinehad AR, Winkler M, et al. Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases. 2022; 25: 174–179.

[25] 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. The Lancet. 2017; 389: 815–822.

[26] Lam TBL, MacLennan S, Willemse PM, Mason MD, Plass K, Shepherd R, et al. EAU-EANM-ESTRO-ESUR-SIOG prostate cancer guideline panel consensus statements for deferred treatment with curative intent for localised prostate cancer from an international collaborative study (DETECTIVE study). European Urology. 2019; 76: 790–813.

[27] Ursprung S, Herrmann J, Nikolaou K, Harland N, Bedke J, Seith F, et al. Die multiparametrische MRT der prostata: anforderungen und grundlagen der befundung. Die Urologie. 2023; 62: 449–458.

[28] Lucarelli NM, Villanova I, Maggialetti N, Greco S, Tarantino F, Russo R, et al. Quantitative ADC: an additional tool in the evaluation of prostate cancer? Journal of Personalized Medicine. 2023; 13: 1378.

[29] Maier SE, Wallström J, Langkilde F, Johansson J, Kuczera S, Hugosson J, et al. Prostate cancer diffusion-weighted magnetic resonance imaging: does the choice of diffusion-weighting level matter? Journal of Magnetic Resonance Imaging. 2022; 55: 842–853.

[30] Spur E, Decelle EA, Cheng LL. Metabolomic imaging of prostate cancer with magnetic resonance spectroscopy and mass spectrometry. European Journal of Nuclear Medicine and Molecular Imaging. 2013; 40: S60–71.

[31] Stamatelatou A, Scheenen TWJ, Heerschap A. Developments in proton MR spectroscopic imaging of prostate cancer. Magnetic Resonance Materials in Physics, Biology and Medicine. 2022; 35: 645–665.

[32] Yang L, Wang L, Tan Y, Dan H, Xian P, Zhang Y, et al. Amide proton transfer-weighted MRI combined with serum prostate-specific antigen levels for differentiating malignant prostate lesions from benign prostate lesions: a retrospective cohort study. Cancer Imaging. 2023; 23: 3.

[33] Guo Z, Qin X, Mu R, Lv J, Meng Z, Zheng W, et al. Amide proton transfer could provide more accurate lesion characterization in the transition zone of the prostate. Journal of Magnetic Resonance Imaging. 2022; 56: 1311–1319.

[34] Qin X, Mu R, Zheng W, Li X, Liu F, Zhuang Z, et al. Comparison and combination of amide proton transfer magnetic resonance imaging and the apparent diffusion coefficient in differentiating the grades of prostate cancer. Quantitative Imaging in Medicine and Surgery. 2023; 13: 812–824.

[35] Chaddad A, Tan G, Liang X, Hassan L, Rathore S, Desrosiers C, et al. Advancements in MRI-based radiomics and artificial intelligence for prostate cancer: a comprehensive review and future prospects. Cancers. 2023; 15: 3839.

[36] Harmon SA, Gesztes W, Young D, Mehralivand S, McKinney Y, Sanford T, et al. Prognostic features of biochemical recurrence of prostate cancer following radical prostatectomy based on multiparametric MRI and immunohistochemistry analysis of MRI-guided biopsy specimens. Radiology. 2021; 299: 613–623.

[37] Chiacchio G, Castellani D, Nedbal C, De Stefano V, Brocca C, Tramanzoli P, et al. Radiomics vs radiologist in prostate cancer. results from a systematic review. World Journal of Urology. 2023; 41: 709–724.

[38] Schelb P, Kohl S, Radtke JP, Wiesenfarth M, Kickingereder P, Bickelhaupt S, et al. Classification of cancer at prostate MRI: deep learning versus clinical PI-RADS assessment. Radiology. 2019; 293: 607–617.

[39] Winkel DJ, Wetterauer C, Matthias MO, Lou B, Shi B, Kamen A, et al. Autonomous detection and classification of PI-RADS lesions in an MRI screening population incorporating multicenter-labeled deep learning and biparametric imaging: proof of concept. Diagnostics. 2020; 10: 951.

[40] Netzer N, Weißer C, Schelb P, Wang X, Qin X, Görtz M, et al. Fully automatic deep learning in bi-institutional prostate magnetic resonance imaging: effects of cohort size and heterogeneity. Investigative Radiology. 2021; 56: 799–808.

[41] Murthy V, Sonni I, Jariwala N, Juarez R, Reiter RE, Raman SS, et al. The role of PSMA PET/CT and PET/MRI in the initial staging of prostate cancer. European Urology Focus. 2021; 7: 258–266.

[42] Dominique G, Brisbane WG, Reiter RE. The utility of prostate MRI within active surveillance: description of the evidence. World Journal of Urology. 2022; 40: 71–77.

[43] Turkbey B, Mani H, Aras O, Ho J, Hoang A, Rastinehad AR, et al. Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology. 2013; 268: 144–152.

[44] Yin H, Wang D, Yan R, Jin X, Hu Y, Zhai Z, et al. Comparison of diffusion kurtosis imaging and amide proton transfer imaging in the diagnosis and risk assessment of prostate cancer. Frontiers in Oncology. 2021; 11: 640906.

[45] Nilsson E, Sandgren K, Grefve J, Jonsson J, Axelsson J, Lindberg AK, et al. The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography. Communications Medicine. 2023; 3: 164.

[46] Park H, Kim SH, Kim JY. Dynamic contrast-enhanced magnetic resonance imaging for risk stratification in patients with prostate cancer. Quantitative Imaging in Medicine and Surgery. 2022; 12: 742–751.

[47] Żurowska A, Pęksa R, Grzywińska M, Panas D, Sowa M, Skrobisz K, et al. Comparison of diffusion kurtosis imaging and standard mono-exponential apparent diffusion coefficient in diagnosis of significant prostate cancer—a correlation with gleason score assessed on whole-mount histopathology specimens. Diagnostics. 2023; 13: 173.

[48] Michallek F, Huisman H, Hamm B, Elezkurtaj S, Maxeiner A, Dewey M. Prediction of prostate cancer grade using fractal analysis of perfusion MRI: retrospective proof-of-principle study. European Radiology. 2022; 32: 3236–3247.

[49] Nahar B, Katims A, Barboza MP, Soodana Prakash N, Venkatramani V, Kava B, et al. Reclassification rates of patients eligible for active surveillance after the addition of magnetic resonance imaging-ultrasound fusion biopsy: an analysis of 7 widely used eligibility criteria. Urology. 2017; 110: 134–139.

[50] Schaeffer E, Srinivas S, Antonarakis ES, Armstrong AJ, Bekelman JE, Cheng H, et al. NCCN guidelines insights: prostate cancer, version 1.2021. Journal of the National Comprehensive Cancer Network. 2021; 19: 134–143.

[51] Park BH, Jeon HG, Choo SH, Jeong BC, Seo SI, Jeon SS, et al. Role of multiparametric 3.0-tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance. BJU International. 2014; 113: 864–870.

[52] Park JJ, Park BK. Role of PI-RADSv2 with multiparametric MRI in determining who needs active surveillance or definitive treatment according to PRIAS. Journal of Magnetic Resonance Imaging. 2017; 45: 1753–1759.

[53] Rais-Bahrami S, Turkbey B, Rastinehad AR, Walton-Diaz A, Hoang AN, Siddiqui MM, et al. Natural history of small index lesions suspicious for prostate cancer on multiparametric MRI: recommendations for interval imaging follow-up. Diagnostic and Interventional Radiology. 2014; 20: 293–298.

[54] 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. European Urology. 2017; 71: 648–655.

[55] Caglic I, Sushentsev N, Gnanapragasam VJ, Sala E, Shaida N, Koo BC, et al. MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance. European Radiology. 2021; 31: 2696–2705.

[56] Eineluoto JT, Järvinen P, Kenttämies A, Kilpeläinen TP, Vasarainen H, Sandeman K, et al. Repeat multiparametric MRI in prostate cancer patients on active surveillance. PLOS ONE. 2017; 12: e0189272.

[57] Perlis N, Al-Kasab T, Ahmad A, Goldberg E, Fadak K, Sayid R, et al. Defining a cohort that may not require repeat prostate biopsy based on PCA3 score and magnetic resonance imaging: the dual negative effect. Journal of Urology. 2018; 199: 1182–1187.

[58] 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. European Urology. 2020; 77: 311–317.

[59] Stavrinides V, Giganti F, Emberton M, Moore CM. MRI in active surveillance: a critical review. Prostate Cancer and Prostatic Diseases. 2019; 22: 5–15.

[60] Stavrinides V, Giganti F, Trock B, Punwani S, Allen C, Kirkham A, et al. Five-year outcomes of magnetic resonance imaging-based active surveillance for prostate cancer: a large cohort study. European Urology. 2020; 78: 443–451.

[61] Gallagher KM, Christopher E, Cameron AJ, Little S, Innes A, Davis G, et al. Four-year outcomes from a multiparametric magnetic resonance imaging (MRI)-based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies. BJU International. 2019; 123: 429–438.

[62] Ploussard G, Beauval JB, Lesourd M, Almeras C, Assoun J, Aziza R, et al. Performance of systematic, MRI-targeted biopsies alone or in combination for the prediction of unfavourable disease in MRI-positive low-risk prostate cancer patients eligible for active surveillance. World Journal of Urology. 2020; 38: 663–671.

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