Recommendation ID

What is the most suitable surveillance protocol (including the role of digital rectal examination [DRE] and prostate-specific antigen [PSA] measures) for people for whom active surveillance is appropriate, as assessed by multiparametric MRI and biopsy, when there are no clinical concerns during follow‑up?

Any explanatory notes
(if applicable)

Why the committee made the recommendations

The committee made recommendations based on a good body of evidence that multiparametric MRI can be used as part of an active surveillance protocol to identify clinically significant cancer, or restage prostate cancer after diagnosis. The committee took into account the benefits seen in using multiparametric MRI pre‑biopsy in people who have not had a biopsy and who have suspected prostate cancer, and concluded that this benefit can be extended to people having active surveillance without having had an MRI to allow for confirmation or reclassification of the prostate cancer.

The committee amended the protocol for active surveillance based on their expertise and good evidence on PSA-derived measures to monitor, and the use of multiparametric MRI to identify, clinically significant prostate cancer. The committee kept the use of digital rectal examination in this population because they did not see any new evidence to not recommend it for this group. In addition, digital rectal examination was part of the protocol in one of the studies included in the evidence review.

Because of the limited evidence on the most effective pathway for excluding clinically significant progression of prostate cancer in people with low to intermediate risk, the committee made research recommendations in this area. They also identified that there was a gap in the evidence on the most suitable surveillance protocol for this population group, including the use of digital rectal examination.

How the recommendations might affect practice

The use of multiparametric MRI in people who are enrolled on active surveillance will influence active surveillance protocols across the country. Multiparametric MRI is clinically and cost effective, because clinically significant cancers are more likely to be identified, therefore decisions on treatment can be made earlier in the diagnosis pathway saving on future treatment costs.

Full details of the evidence and the committee's discussion are in evidence review F: identifying prostate cancer clinical progression in people with low- to intermediate-risk cancer.

Source guidance details

Comes from guidance
Prostate cancer: diagnosis and management
Date issued
May 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 09/05/2019