Active surveillance and modern diagnostics of prostate cancer. Multiparametric MRI, fusion-targeted biopsy and new genetic biomarkers

BackgroundPrimary transrectal ultrasound random biopsies do not detect all prostate cancer foci, leading to the necessity of repeat biopsies if prostate cancer suspicion persists. Moreover, corresponding false negative rates and discrepancies between biopsy Gleason scores and final radical prostatectomy pathology must be considered. These challenges potentially lead to delayed diagnosis and enable prostate cancer to gain aggressive tumor features and can be acommon reason for understaging, adverse patient outcomes or missing the window of opportunity for acure. Multiparametric magnetic resonance imaging (mpMRI) and genetic biomarkers might represent solutions to further improve prostate cancer detection and characterization in order to optimize treatment choice, such as active surveillance inclusion and monitoring.ObjectiveThis article provides an overview of active surveillance definitions, pitfalls of prostate cancer detection and characterization, implementation of mpMRI, MRI fusion targeted biopsy and genetic biomarkers as possible solutions and the integration into daily clinical practice.Material and methodsReview of the current literature and institutional experiences.ResultsThe mpMRI and MRI fusion targeted biopsy are superior to the current standard of transrectal ultrasound random biopsy in the detection of clinically significant prostate cancer. This is particularly shown in the setting of previous negative biopsy, anterior prostate cancer, persistence of suspicious PSA dynamics and active surveillance inclusion and monitoring. Similarly, the combination of other novel predictors represent promising approaches.ConclusionThe potential diagnostic value can only be achieved by an interdisciplinary combination of increasingly complex diagnostic steps. Effective solutions within the framework of interdisciplinary cooperation between radiologists and urologists at the level of the specialist societies are necessary in order to address questions regarding time expenditure and resource distribution with service providers.