Ten Years of MRI-Driven Prostate Cancer Diagnosis and Active Surveillance: Trends and Implications

Since the 2012 publication of Prostate Imaging-Reporting and Data System (PI-RADS) recommendations (1), pre-biopsy MRI has emerged as the first-line diagnostic test in patients with suspected clinically localised prostate cancer (PCa). Initially endorsed by European and British guidelines in 2019 (2,3) and subsequently reflected in the major North American guidelines (4,5), this approach is supported by level-1 evidence showing MRI reduces unnecessary biopsies in patients without MRI-identified suspicious lesions, while maintaining acceptable detection rates for clinically significant PCa (csPCa). These guidelines also recommend MRI for eligibility assessment and subsequent follow-up of PCa patients on active surveillance (AS), a management strategy with increasing global uptake (6).