Active surveillance (AS) is the recommended treatment option for low-risk and favourable intermediate-risk prostate cancer management, preserving oncological and functional outcomes. However, active monitoring using relevant parameters in addition to the usual clinical, biological and pathological considerations is necessary to compensate for initial undergrading of the tumour or to detect early progression without missing the opportunity to provide curative therapy. Indeed, several studies have raised concerns about inadequate biopsy sampling at diagnosis. However, the implementation of baseline MRI and targeted biopsy have led to improved initial stratification of low-risk disease; baseline MRI correlates well with disease characteristics and AS outcomes. The use of follow-up MRI during the surveillance phase also raises the question of the requirement for serial biopsies in the absence of radiological progression and the possibility of using completely MRI-based surveillance, with triggers for biopsies based solely on MRI findings. This concept of a tailored-risk, imaging-based monitoring strategy is aimed at reducing invasive procedures. However, the abandonment of serial biopsies in the absence of MRI progression can probably not yet be recommended in routine practice, as the data from real-life cohorts are heterogeneous and inconclusive. Thus, the evolution towards a routine, fully MRI-guided AS pathway has to be preceded by ensuring quality programme assessment for MRI reading and by demonstrating its safety in prospective trials.

主动监测 (AS) 是低风险和有利的中等风险前列腺癌管理的推荐治疗选择，可保持肿瘤和功能结果。然而，除了通常的临床、生物学和病理学考虑因素之外，还需要使用相关参数进行主动监测，以补偿肿瘤的初始低度分级或检测早期进展而不错过提供治愈性治疗的机会。事实上，一些研究已经引起了对诊断时活检取样不充分的担忧。然而，基线 MRI 和靶向活检的实施改善了低风险疾病的初始分层；基线 MRI 与疾病特征和 AS 结果密切相关。在监测阶段使用 MRI 随访也提出了在没有放射学进展的情况下需要连续活检的问题，以及使用完全基于 MRI 的监测的可能性，仅根据 MRI 结果触发活检。这种基于成像的定制风险监控策略的概念旨在减少侵入性操作。然而，在常规实践中可能还不推荐在没有 MRI 进展的情况下放弃连续活检，因为来自现实生活队列的数据是异质的和不确定的。因此，在向常规、完全 MRI 引导的 AS 路径发展之前，必须先确保 MRI 阅读的质量程序评估，并在前瞻性试验中证明其安全性。