Kornienko K, Siegel F, Borkowetz A, et al. - According to findings, merely a moderate number of prostate cancer (PCa) cases can be monitored via active surveillance (AS) to defer active treatment employing current guidelines for inclusion in a real-world setting. A marked decrease in this number was evident by an additional magnetic resonance imaging - targeted biopsy (MRI-TB). Findings highlight the necessity for a contemporary adjustment of AS inclusion criteria.

• This retrospective multicenter study, including men having PCa and at least one MRI-visible lesion by Prostate Imaging Reporting and Data System (PI-RADS) v2, was conducted to compare AS eligibility by systematic biopsy (SB) and combined MRI-targeted (MRI-TB) and SB within real-world data applying current AS guidelines.

• Among 1941 PCa patients, per guideline, 583–1112 in both MRI-TB and SB were available for study.

• Eligibility for AS was met by a median of 22.1% (range 6.4–72.4%), using SB.

• A median of 15% (range 1.7–68.3%) were eligible for AS when the combined approach was employed.

• A 32.1% decrease of suitable cases occurred due to addition of MRI-TB.

• The most frequent exclusion criterion, besides Gleason Score upgrading, was the maximum number of positive cores.