Volume 19, Number 2Review ArticlesActive Surveillance of Prostate Cancer: Current State of Practice and Utility of Multiparametric Magnetic Resonance ImagingPractice UpdateH Ballentine CarterJonathan I EpsteinRidwan AlamJeffrey J TosoianActive surveillance (AS) is an alternative to immediate intervention in patients with very low- and low-risk prostate cancer. Ongoing reports from multiple AS programs have consistently demonstrated a very low rate of metastasis and prostate cancer-specific mortality in appropriately selected patients. Accordingly, AS has been adopted by major clinical organizations as a safe and effective management strategy. Clinical focus has now shifted to identifying the optimal approach to selecting and monitoring patients. Multiparametric magnetic resonance imaging (mpMRI) has emerged as one potentially helpful tool in the AS setting. The utility of mpMRI has been well demonstrated in the setting of screening and diagnosis, but its role in AS remains unclear. We summarize the published experience with AS and review pertinent, contemporary data on the use of mpMRI in the setting of AS. [Rev Urol. 2017;19(2):77–88 doi: 10.3909/riu0757] © 2017 MedReviews®, LLCProstate cancerActive surveillanceMultiparametric magnetic resonance imaging