Magnetic Resonance Imaging and Multivariable Risk-stratification in Prostate Cancer Screening and Active Surveillance

Prostate cancer screening is controversial as it saves lives, but is also associated with the harms of unnecessary testing (i.e. prostate biopsies) and overdiagnosis of clinically insignificant prostate cancer. Within this thesis it is shown that the use of magnetic resonance imaging and multivariable risk-stratification can significantly reduce these harms of prostate cancer screening. Nowadays, men who are diagnosed with clinically insignificant prostate cancer are often followed-up according to a strict protocol (active surveillance) instead of receiving surgery or radiotherapy, thereby preventing or delaying potential side-effects of these treatments. However, the repeated prostate biopsies during follow-up on active surveillance are also considered burdening by patients. Within this thesis it is shown that the use of magnetic resonance imaging and risk-stratification can result in an improved selection of patients who are suitable for active surveillance and can safely reduce the number of follow-up biopsies during surveillance.

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