Jamie Michael, MD, discusses MRI and genomics in active surveillance

In the following interview, Jamie Michael, MD, discusses a retrospective analysis evaluating whether prebiopsy MRI and Decipher genomic testing can improve patient selection for active surveillance (AS) and reduce the risk of "extreme" grade reclassification in men with prostate cancer.¹ These findings were presented at the 2026 American Urological Association Annual Meeting in Washington, DC. Michael is a urology resident at Northwestern Medicine in Chicago, Illinois.

Michael explained that as AS has become an increasingly common management strategy for low-risk prostate cancer, careful patient selection is essential to avoid delaying definitive treatment for men with more aggressive disease. She noted that multiparametric MRI has become a cornerstone of contemporary diagnostic evaluation because MRI-guided biopsy can better identify clinically significant lesions that may be missed with standard systematic biopsy, particularly in the anterior and transition zones. At the same time, the Decipher genomic classifier, originally developed to risk stratify patients after radical prostatectomy, is being explored as an additional tool to refine AS eligibility. Her team sought to determine how MRI and Decipher have influenced patient selection and surveillance outcomes within Northwestern Medicine's 11-hospital AS registry.

The retrospective study included 1200 men managed with AS between 2018 and 2024 and compared rates of extreme reclassification—defined as progression to Gleason Grade Group 3 to 5 disease—among patients who underwent both MRI and Decipher testing, MRI alone, or neither. Michael reported that the lowest rate of extreme reclassification was observed in men who received both MRI and Decipher before diagnostic biopsy (9.6%), compared with 10% among those who underwent MRI alone and 17% among those who had neither MRI nor Decipher (P = .001). She suggested these findings indicate that advanced imaging and genomic testing may help identify higher-risk patients who are better suited for upfront treatment rather than surveillance, thereby reducing the likelihood of significant upgrading during follow-up.

Although only 135 patients in the cohort underwent both MRI and Decipher testing, Michael said the investigators observed trends on univariate analysis suggesting that GG2 at diagnosis, Decipher genomic score, PIRADS 4-5 disease and increasing NCCN risk were associated with greater risk of extreme reclassification, although none of these reached statistical significance.

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