Acknowledgements

involvement of every positive core, and GS 3 + 3 [7]. Patients fulfilling this criteria

AS consists of a close disease monitoring through clinical and histological parameters: commonly used tools are serial PSA measurements, DRE, and repeat biopsies [2, 7]. If biochemical or histological evidence of cancer progression is

underestimating the extent and aggressiveness of prostate cancer. Some authors have reported that TRUS-guided biopsies may lead to an underestimation in one

At the time of initial diagnosis, the mp-MRI is much more accurate in the identification and characterization of prostate cancers, resulting in a more accurate patients enrollment for the AS protocol. Its use is recommended to rule out signif-

mp-MRI is currently emerging as a significant diagnostic tool through which the above risk can be minimized. It can be used in one of the three following stages: at the time of initial diagnosis of men with low-risk cancer, before confirmatory

Before the confirmatory biopsy, usually performed within the first year from the initial diagnosis, the mp-MRI can reveal the need to perform a targeted biopsy in addition to the commonly adopted standard biopsy. The combined use of these two techniques may lead to a more accurate evidence of disease progression [47–49]. This is in line with the review performed by Schoots et al. [48] according to which the combined execution of targeted and standard biopsies resulted in 27% cancer upgrading. It is therefore recommended that both biopsy techniques be adopted at

During the follow-up period, a yearly mp-MRI might allow the annual biopsy to be avoided for those patients with stable MRI findings. The repeat biopsy should be performed only in the event that a disease progression is detected by the mp-MRI [47]. It should be noted however that there is still no definitive agreement on the use of the mp-MRI as a replacement for the repeat biopsy during the follow-up

• For many years the TRUS-guided biopsy has been considered as the gold standard in the diagnosis of PCa. Even if the ultrasound-based imaging is a great tool for guiding a biopsy needle, it cannot identify regions of interest that could harbor PCa in all cases. This is the reason why in the last decade, the research activities have focused on the development of imaging methods that can differentiate between noncancerous tissue and malignant lesions with

• The introduction of mp-MRI as an imaging modality for the detection and localization of regions of interest has nowadays revolutionized the way through which PCa is managed and treated. According to the ESUR guidelines, the mp-

• PI-RADS v2 was introduced by the ESUR to standardize the evaluation and reporting of mp-MRI examinations. This 5-point scoring system is based on the

likelihood that MRI findings correlate with the presence of Cs PCa.

MRI protocol should include T2W, DWI, and DCE sequences.

may benefit from AS, reducing treatment-related complications without

The main limitation associated with the AS protocol is the risk of

observed, a radical treatment will then be proposed [2, 47, 48].

compromising their survival.

Male Reproductive Health

third of cases [47, 48, 50].

period [49].

Key points

142

greater accuracy.

biopsy and during follow-up [49].

icant PCas that were missed by the initial biopsy.

the stage of the confirmatory biopsy [48, 49].

Funder: TECNOGAMMA snc; Corso Lombardia 75; San Mauro Torinese; Italy.
