Sperling Prostate Center

No News is Good News (for mpMRI During Active Surveillance)

We’ve all heard the saying that no news is good news. It’s meant to be reassuring in the face of worry over an unknown outcome. The news must not be bad, because you would have heard if it were.

When it comes to using multiparametric MRI (mpMRI) for Active Surveillance (AS) monitoring, a negative scan means everything is going in the patient’s favor because his prostate cancer is holding steady. If it weren’t, it would have known it because it would have shown up on the scan.

This point was made by a speaker, Jacob Enders, BS, at the American Urological Association’s 2022 annual meeting in New Orleans, Louisiana. He represented a clinical team at the Cleveland Clinic Lerner College of Medicine/Case Western Reserve School of Medicine (Ohio). He discussed their study of 466 prostate cancer (PCa) patients on AS monitoring who had an average of four mpMRIs during 3.4 years of monitoring. 120 of them (25.7%) had at least one negative scan. “Among the 95 prostate biopsies performed in this group, 34.7% displayed tumors of equal-grade to the previous pathology and 49.5% showed lower-grade tumors.”[i] However, nine out of the 73 had biopsies found an upgrade to Grade Group 2 or higher, but these men averaged higher PSA density on their monitoring bloodwork.

Thus, patients on AS who have a negative MRI and low PSA density have a low likelihood for PCa progression, and therefore (here is the good news) may be able to defer having a biopsy. In other words, no mpMRI news—that is, no significant lesions—is good news for such patients because it means their disease is stable, and they can hold off on a repeat biopsy.

A little trivia

Where did the saying “no news is good news” come from? History traces it back to royalty in the early 1600s. It is attributed to King James 1 of Scotland, who reportedly said, “No news is better than evil news.” This conveys the same idea but comes at it from the negative, evil news. Then, bookbrowse.com tells us, “The first recorded use of this exact expression in English is by James Howell in 1640, who wrote, “I am of the Italians’ mind that said, ‘Nulla nuova, buona nuova’ (no news, good news).” This phrasing transforms it into a positive: good news. In short, when mpMRI is incorporated into AS monitoring, no finding is indeed good news.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Persaud, Natasha. “Negative MRI in Active Surveillance Often Predicts Stable Prostate Cancer.” Renal & Urology News, May 15, 2022. https://www.renalandurologynews.com/home/news/negative-mri-in-prostate-cancer-active surveillance-often-suggests-stable-disease/


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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