Dominique G, Brisbane WG, Reiter RE, et al. - Findings demonstrate usefulness of magnetic resonance imaging (MRI) in initial risk stratification of prostate cancer in men on active surveillance, particularly if MRI is negative when imaging is acquired during surveillance. MRI can not be a substitute for biopsy.

• This is an overview of the literature on the use of MRI in active surveillance of prostate cancer.

• Studies of men on active surveillance with MRI and later confirmatory biopsy were selected from MEDLINE and Cochrane Library.

• Within active surveillance, baseline MRI proved effective for detecting clinically significant prostate cancer and therefore related to fewer reclassification events.

• A positive predictive value (PPV) of 35–40%, for reclassification by 3 years, was demonstrated by a positive initial MRI (≥ PI-RADS 3) with GG1 detected at biopsy.

• A stronger negative predictive value of MRI was evident, with a negative MRI (≤ PI-RADS 2) offering a negative predictive value of up to 85% at 3 years.

• A PPV of 11–65% and negative predictive value of 85–95% for reclassification were conferred by surveillance MRI obtained following initial biopsy.