AUTHOR=Glaser Zachary A. , Gordetsky Jennifer B. , Porter Kristin K. , Varambally Sooryanarayana , Rais-Bahrami Soroush 

TITLE=Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

JOURNAL=Frontiers in Oncology

VOLUME=Volume 7 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2017.00256

DOI=10.3389/fonc.2017.00256

ISSN=2234-943X

ABSTRACT=Background
Active surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as 1 in 4 patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities.

Methods
An English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging and biomarkers published within the past three years.  Our Boolean criteria included the following terms: prostate cancer, active surveillance, imaging, biomarker, genetic, genomic, prospective, retrospective and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search.

Results
Our review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting.

Conclusions
In the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure have shown some initial promise, but further validation is warranted.