Active surveillance in low risk prostate cancer: Role of multiparametric MRI and cancer progression predictors

Introduction: To evaluate the outcomes of active surveillance (AS) strategy for patients with favorable risk prostate cancer (PCa) and identify multiparametric MRI role and PCa progression predictors.Method: This was a 5-year follow-up cohort study which enrolled 153 favorable-risk PCa patients in an AS program from April 2017 to February 2023. Patients were included in this study based on AS protocol inclusion criteria. MpMRI was also a part of this protocol. Active surveillance outcomes such as adherence to AS treatment strategy and the oncologic outcomes were assessed.Results: During the 4.23 +/- 0.5 years follow-up, 39 of 153 patients left the AS protocol by their own decision (14) or other physicians' advice, due to the concern of cancer progression; 5 of 153 died from another cause other than PCa; 9 of 153 revealed cancer progression during this time and underwent radical prostatectomy; The remaining 100 patients stayed on the AS protocol during the follow up. Adherence to AS strategy protocol was 60.55% in our study. Older age, positive family history for PCa, initial clinical stage, higher total PSA, greater PSA density, more positive cores, and greater core involvement were the most common predictors for progression. The sensitivity, specificity, positive predictive value, and negative predictive value of mpMRI for cancer progression detection were 55.55%, 97%, 62.25%, and 96%, respectively.Conclusion: AS can be a suitable alternative treatment for low-risk and very low risk prostate cancer to avoid the probable complications of radical prostatectomy. MpMRI is valid and reliable for identifying PCa progression and provides useful information when combined with biopsy.