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This retrospective look at outcomes for 1450 men undergoing active surveillance for low to intermediate risk prostate cancer at UCSF between 1990 - 2018 assesses risk of metastases over time. Remarkably, only 15 men (1%) developed mets at a median time of over 5 years, and two-thirds of those were to lymph nodes only. So it makes sense that, at 7 years, less than 1% died of prostate cancer. Which patients were at slightly higher risk? Predictably those with grade group 2 disease and a high PSA velocity and more interestingly those with prostate lesions that were PI-RADS 4-5. TBL: Multiparametric MRI may be an important component of selecting appropriate candidates for active surveillance of lower risk prostate cancer. | Maggi, J Urol 2020

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