In a prospective trial of 172 patients who underwent active surveillance, in which at 3 years 21% experienced pathological progression, MRI using PI-RADS was able to identify many of them (a sensitivity of 61% and a specificity of 80%) [82]. In addition, in a study in which 86 patients who had diffusion-weighted imaging as part of their baseline assessment for active surveillance and followed up for a median of 9.5 years, it was able to predict patients with a shorter time to adverse histology (hazard ratio [HR] = 2.13, 95% CI: 1.17-3.89) and a shorter time to radical treatment (HR 2.54, 95% CI: 1.49-4.32; P < . 001) [83]. MRI can also be used in conjunction with nonimaging biomarkers to better identify patients with an increased risk of biopsy upgrading [84]. MRI Pelvis Without IV Contrast Initial imaging without using IV contrast is also a viable option based on the identical rationales for using MRI of the pelvis with IV contrast [81-84]. Especially, there are studies that specifically address the usage of diffusion- weighted imaging (which is typical done without or prior to administration of IV contrast) for baseline assessment on active surveillance, demonstrating that it was helpful for predicting patients with shorter time to adverse histology and radical treatment [83]. MRI Whole Body Without and With IV Contrast There is limited evidence to support the use of MRI whole body without and with IV contrast for active surveillance of patients with clinically established low-risk prostate cancer. MRI Whole Body Without IV Contrast There is limited evidence to support the use of MRI whole body without IV contrast for active surveillance of patients with clinically established low-risk prostate cancer. PSMA PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of PSMA PET/CT (or PET/MRI) for active surveillance of patients with clinically established low-risk prostate cancer. Pretreatment Detection of Prostate Cancer
Pretreatment Detection Surveillance and Staging of Prostate Cancer. In a prospective trial of 172 patients who underwent active surveillance, in which at 3 years 21% experienced pathological progression, MRI using PI-RADS was able to identify many of them (a sensitivity of 61% and a specificity of 80%) [82]. In addition, in a study in which 86 patients who had diffusion-weighted imaging as part of their baseline assessment for active surveillance and followed up for a median of 9.5 years, it was able to predict patients with a shorter time to adverse histology (hazard ratio [HR] = 2.13, 95% CI: 1.17-3.89) and a shorter time to radical treatment (HR 2.54, 95% CI: 1.49-4.32; P < . 001) [83]. MRI can also be used in conjunction with nonimaging biomarkers to better identify patients with an increased risk of biopsy upgrading [84]. MRI Pelvis Without IV Contrast Initial imaging without using IV contrast is also a viable option based on the identical rationales for using MRI of the pelvis with IV contrast [81-84]. Especially, there are studies that specifically address the usage of diffusion- weighted imaging (which is typical done without or prior to administration of IV contrast) for baseline assessment on active surveillance, demonstrating that it was helpful for predicting patients with shorter time to adverse histology and radical treatment [83]. MRI Whole Body Without and With IV Contrast There is limited evidence to support the use of MRI whole body without and with IV contrast for active surveillance of patients with clinically established low-risk prostate cancer. MRI Whole Body Without IV Contrast There is limited evidence to support the use of MRI whole body without IV contrast for active surveillance of patients with clinically established low-risk prostate cancer. PSMA PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of PSMA PET/CT (or PET/MRI) for active surveillance of patients with clinically established low-risk prostate cancer. Pretreatment Detection of Prostate Cancer