主动监测 (AS) 是一种保守的管理选择，建议诊断为低危前列腺癌 (PCa) 的患者和选定的中危 PCa 病例。前列腺 MRI 在初级诊断中的采用引发了人们对其在 AS 期间应用的兴趣。本综述旨在探讨多参数 MRI (mpMRI) 在整个 AS 通路中的作用和性能，从初始分层到随访，也与前列腺癌序贯评估变化放射学估计 (PRECISE) 标准的使用相关。鉴于 mpMRI 在检测有临床意义的 PCa (csPCa) 方面具有较高的阴性预测价值，强有力的证据支持其在诊断或验证性活检时用于患者选择和风险分层。然而，在随访期间使用 MRI 评估疾病进展时，观察到了相互矛盾的结果。需要澄清的关键领域包括解决 MRI 阴性 csPCa 的临床意义、优化 MRI 质量、确定双参数 MRI (bpMRI) 或 mpMRI 方案的作用，以及集成人工智能 (AI) 以提高性能。临床相关性声明：MRI 在前列腺癌主动监测 (AS) 患者的选择、分层和随访中发挥着重要作用。然而，由于现有的局限性，它不能完全取代 AS 的活检。要点：多参数 MRI (mpMRI) 已成为前列腺癌 (PCa) 主动监测 (AS) 的重要工具。关于多参数 MRI 在评估疾病进展方面的功效，观察到了相互矛盾的结果。标准化 MRI 引导方案对于解决当前前列腺癌主动监测的局限性至关重要。© 2024。作者获得欧洲放射学会的独家许可。

Active surveillance (AS) is a conservative management option recommended for patients diagnosed with low-risk prostate cancer (PCa) and selected cases with intermediate-risk PCa. The adoption of prostate MRI in the primary diagnostic setting has sparked interest in its application during AS. This review aims to examine the role and performance of multiparametric MRI (mpMRI) across the entire AS pathway, from initial stratification to follow-up, also relative to the utilization of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) criteria. Given the high negative predictive value of mpMRI in detecting clinically significant PCa (csPCa), robust evidence supports its use in patient selection and risk stratification at the time of diagnosis or confirmatory biopsy. However, conflicting results have been observed when using MRI in evaluating disease progression during follow-up. Key areas requiring clarification include addressing the clinical significance of MRI-negative csPCa, optimizing MRI quality, determining the role of biparametric MRI (bpMRI) or mpMRI protocols, and integrating artificial intelligence (AI) for improved performance. CLINICAL RELEVANCE STATEMENT: MRI plays an essential role in the selection, stratification, and follow up of patients in active surveillance (AS) for prostate cancer. However, owing to existing limitations, it cannot fully replace biopsies in the context of AS. KEY POINTS: Multiparametric MRI (mpMRI) has become a crucial tool in active surveillance (AS) for prostate cancer (PCa). Conflicting results have been observed regarding multiparametric MRI efficacy in assessing disease progression. Standardizing MRI-guided protocols will be critical in addressing current limitations in active surveillance for prostate cancer.© 2024. The Author(s), under exclusive licence to European Society of Radiology.