Active surveillance monitoring: the role of novel biomarkers and imaging

Avicenna's Concepts on Cancer Metastasis from the 11th Century

From ancient times to the era of industrialization, medical and philosophical scholars have long been wondering about the nature and the underlying mystery of cancer. Despite the extensive efforts in recent decades trying to shed light on the true histopathologic basis of malignancies, many questions remain to be elucidated. Thus, it's not surprising that even the most notable predecessor physicians knew only very little about cancer and metastasis. In this paper, we present a brief review of the historical assumptions about the origin and spread of tumoral growths. Subsequently, we will look at an impressing notion by Avicenna about the possibility of local metastasis, which had remained unacknowledged so far and highlights the intellect of this great Persian physician even further.

MR Imaging for Prostate Cancer Screening and Active Surveillance

The current prostate cancer management paradigm has been criticized in recent years for contributing to the overdiagnosis and overtreatment of the disease. Active surveillance is an avenue by which to reduce overtreatment, but patient selection and monitoring remain a challenge. The use of prostate MR imaging has been growing in recent years and has been incorporated into prostate cancer screening and patient selection and monitoring for active surveillance. This review article discusses the current evidence for the use of MR imaging in each of those settings.

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

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 one in four 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 3 years. Our Boolean criteria included the following terms: PCa, AS, 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.

Conclusion

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 has shown some initial promise, but further validation is warranted.