MRI-derived radiomics for prostate cancer active surveillance: a systematic review.
Authors
Affiliations (7)
Affiliations (7)
- School of Medicine, Trinity College Dublin, College Green, Dublin 2 D02 PN40, Ireland; Trinity St James's Cancer Institute, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland; Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Electronic address: [email protected].
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
- Department of Urology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia.
- Department of Radiology, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland.
- Department of Urology, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland.
- School of Medicine, Trinity College Dublin, College Green, Dublin 2 D02 PN40, Ireland; Trinity St James's Cancer Institute, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland; Department of Urology, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland.
- School of Medicine, Trinity College Dublin, College Green, Dublin 2 D02 PN40, Ireland; Trinity St James's Cancer Institute, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland; Department of Surgery, St James's Hospital, James's Street, Dublin 8 D08 NHY1, Ireland.
Abstract
To systematically review MRI-derived radiomic and artificial intelligence models predicting outcomes in men on or eligible for active surveillance (AS) for prostate cancer, and whether reported endpoints permit quantitative synthesis. Following PRISMA 2020, we searched PubMed, Scopus, Embase, and Web of Science (2000-September 2026). Two reviewers independently screened, extracted data, and assessed risk of bias (QUADAS-2, PROBAST) and methodological quality (METRICS). Three subgroups were defined: AS selection at diagnosis, baseline detection of clinically significant cancer, and progression during follow-up. Pooling was pre-specified for subgroups with at least four independent cohorts; endpoint equivalence was assessed. Seventeen studies across 12 unique cohorts were included. Seven publications derived from two cohorts; 12 independent cohort-level estimates (n = 2703) remained after overlap resolution. Nine publications (four independent cohorts) addressed progression (AUC 0.70 to 0.95), but progression was defined in five non-equivalent ways, from any grade-group increase to composite core-count criteria, precluding quantitative synthesis. Risk of bias was high or unclear in 16 of 17 studies; the median METRICS score was 32.3 % (range 18.9-52.3 %). No study reported external validation or calibration for progression. Progression endpoints were heterogeneous and several were of limited clinical relevance. A core outcome set for AS (at least ISUP grade group ≥3 and/or unequivocal radiological progression), followed by multi-centre external validation with a head-to-head comparison against the PRECISE v2 (Prostate Cancer Radiological Estimation of Change in Sequential Evaluation) score, is the priority before clinical use can be considered.