The role of magnetic resonance imaging in the active surveillance of prostate cancer: state of the art.
TL;DR
The standardized integration of mpMRI, PI-QUAL v2, and PRECISE v2 enables more structured patient monitoring and supports multidisciplinary decision-making and may further enhance the objectivity and effectiveness of active surveillance.
Abstract
POURPOSE To provide an update on the role of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) of prostate cancer, with particular focus on standardizing image acquisition and reporting through PI-RADS v2.1, PI-QUAL v2, and PRECISE v2, as well as their clinical implications in risk stratification and follow-up.
Materials And Methods
Narrative review of the literature and the most recent international guidelines on the use of mpMRI in patients undergoing AS. Selection criteria, follow-up protocols (12-24 months), imaging quality parameters (PI-QUAL v2), the longitudinal assessment system PRECISE v2, and the main radiological triggers for re-biopsy and multidisciplinary discussion were analyzed.
Results
Baseline mpMRI improves candidate selection and reduces the risk of underestimating clinically significant disease. During follow-up, radiological progression shows a sensitivity of approximately 59% and specificity of approximately 75%, with a high negative predictive value (81-88%) but moderate positive predictive value. PRECISE v2 introduces updated categories, mandatory integration of image quality assessment, and systematic comparison with prior examinations, thereby improving reproducibility and comparability.
Conclusions
The standardized integration of mpMRI, PI-QUAL v2, and PRECISE v2 enables more structured patient monitoring and supports multidisciplinary decision-making. However, mpMRI does not replace scheduled biopsies. The implementation of radiomics and artificial intelligence may further enhance the objectivity and effectiveness of active surveillance.