How MRI is changing prostate cancer management: a focus on early detection and active surveillance

Introduction: The last decade has witnessed major changes in prostate cancer management. Among these, the advent of magnetic resonance imaging (MRI), by allowing the visualisation of the cancerous lesion inside the prostatic gland, opened new management horizons. Material and methods: We conducted a narrative review of the literature published since 2010, focusing on the place of MRI in the early detection, active surveillance and prostate cancer screening settings. Results: Multiparametric magnetic resonance imaging (mpMRI), interpreted using the PIRADS scoring system, has allowed a shift from systematic to mpMRI-targeted biopsies, supported by level I evidence. Studies are ongoing to evaluate the role of MRI as a triage and screening tool. The integration of mpMRI has allowed for a better selection of active surveillance candidates, reducing the risk of misclassi cation. The PRECISE recommendations have been created to assess the likelihood of radiological change over time from the previous or baseline mpMRI scan, and serial mpMRI appears promising to reduce the need for repeat biopsy in active surveillance. Conclusion: Growing evidence supports the use of MRI at all stages of the prostate cancer pathway, relying on images of optimal diagnostic quality and experience in prostate MRI reporting and biopsy targeting. (C) 2022 Elsevier Masson SAS. All rights reserved.