More Accurate Active Surveillance with mpMRI
Who Qualifies for Active Surveillance (AS)?
A recommendation for Active Surveillance is typically based on a diagnosis of low-risk prostate cancer, mpMRI results, and other factors, including:
- PSA level of less than 10
- Stage T2a or lower
- Gleason score of 3+3
- Patient’s age and life expectancy
- Patient’s preferences and lifestyle
- Psychological tolerance for leaving cancer untreated
- Genomic factors may also be considered
There may be exceptions to these guidelines. The decision to pursue AS should be made through a detailed discussion with your healthcare provider.
Active Surveillance and How It’s Monitored
Active Surveillance (AS) manages early-stage, low-risk prostate cancer by delaying treatments like surgery or radiation. The goal is to avoid urinary and sexual side effects from conventional treatments while monitoring the cancer. AS helps maintain quality of life while tracking cancer progression. About 30-50% of patients on AS will need treatment within five years.
The success of AS relies heavily on regular monitoring, typically through periodic PSA blood tests and digital rectal exams (DRE). Most traditional protocols also recommend repeat biopsies every 1-2 years as a precaution. Doctors often perform a repeat biopsy if PSA levels rise or if an abnormal DRE suggests the cancer is growing or becoming more aggressive.
There is a significant issue with this monitoring approach. PSA and DRE do not provide enough detailed information, prompting patients to undergo repeat TRUS biopsies. Unfortunately, TRUS biopsies miss 30-40% of cancers, and studies have shown that subsequent biopsies often fail to detect cancers in the same areas. Additionally, the risk of side effects from biopsies increases with each repeat procedure. However, there is a more effective way to monitor cancer during AS.
4 Reasons In-Bore mpMRI-Guided Biopsy is the Best
- Standard TRUS biopsies (using 12 or more needles) miss at least 30% of significant prostate cancers.
- TRUS biopsies carry a higher risk of infection due to the larger number of needles used.
- MRI/ultrasound fusion-guided biopsies can be distorted and inaccurate, often leading to additional random TRUS biopsies “just to be safe.”
- In-bore MRI-targeted biopsies use fewer needles while achieving greater accuracy, ensuring the best possible results.
Men on Active Surveillance may NOT need an immediate TRUS biopsy if their PSA levels start to rise.
To address the limitations of traditional PSA and biopsy monitoring, BlueLaser™ 3T mpMRI of the prostate offers a more advanced solution. This cutting-edge imaging technology provides detailed insights into the size, shape, location, and even the aggressiveness of prostate cancer.
About six weeks after the initial diagnosis (to allow time for post-biopsy bleeding to subside), we offer a baseline mpMRI scan to track the tumor’s progression while the patient is on Active Surveillance. Doctors use this baseline imaging as a reference point for future scans and to reveal any significant cancer missed in the first biopsy. If this happens, the patient may no longer be a candidate for AS. Moving forward, in addition to regular PSA tests, an annual 3T mpMRI offers superior monitoring, even if PSA and DRE remain stable.
However, if PSA or DRE results raise concerns, the immediate next step should be an mpMRI before considering a biopsy. Our experts use BlueLaser™ 3T mpMRI to detect new activity, determine biopsy needs, and assess the patient’s risk. Some national guidelines even suggest that mpMRI can replace repeat biopsies for patients with suspicious PSA results, such as rising PSA levels or a short PSA doubling time.
What if a Biopsy is Necessary?
If further testing is required after MRI imaging, a real-time MRI-guided targeted biopsy will provide the most accurate results. While the patient is in the MRI scanner, Dr. Sperling uses a minimal number of needles to precisely target the tumor’s core. This method avoids overdetecting insignificant cancers by focusing on the areas most likely to contain dangerous cells. Fewer needles and a more accurate diagnosis remove the guesswork from Active Surveillance (AS).
It’s important to remember that Active Surveillance is not a passive approach. It involves taking an active role in monitoring your health and promoting wellness without allowing cancer or its treatment to dominate or harm your life. Lifestyle factors such as diet, exercise, and stress management are key components of AS, as they strengthen the immune system and enhance the body’s natural cancer-fighting capabilities.
While multiparametric MRI is not the only aspect of effective AS, it is essential. When combined with periodic PSA tests, it provides the best information for making informed decisions about AS, biopsy, treatment, and follow-up care. We offer AS patients the confidence that their monitoring goes well beyond the standard of care for Active Surveillance.