ESR Essentials: using the right scoring system in prostate MRI-practice recommendations by ESUR.

MRI has gained prominence in the diagnostic workup of prostate cancer (PCa) patients, with the Prostate Imaging Reporting and Data System (PI-RADS) being widely used for cancer detection. Beyond PI-RADS, other MRI-based scoring tools have emerged to address broader aspects within the PCa domain. However, the multitude of available MRI-based grading systems has led to inconsistencies in their application within clinical workflows. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) assesses the likelihood of clinically significant radiological changes of PCa during active surveillance, and the Prostate Imaging for Local Recurrence Reporting (PI-RR) scoring system evaluates the risk of local recurrence after whole-gland therapies with curative intent. Underlying any system is the requirement to assess image quality using the Prostate Imaging Quality Scoring System (PI-QUAL). This article offers practicing radiologists a comprehensive overview of currently available scoring systems with clinical evidence supporting their use for managing PCa patients to enhance consistency in interpretation and facilitate effective communication with referring clinicians. KEY POINTS: Assessing image quality is essential for all prostate MRI interpretations and the PI-QUAL score represents  the standardized tool for this purpose. Current urological clinical guidelines for prostate cancer diagnosis and localization recommend adhering to the PI-RADS recommendations. The PRECISE and PI-RR scoring systems can be used for assessing radiological changes of prostate cancer during active surveillance and the likelihood of local recurrence after radical treatments respectively.

European radiology. 2024 May 23 [Epub ahead of print]

Andrea Ponsiglione, Giorgio Brembilla, Renato Cuocolo, Patricia Gutierrez, Ana Sofia Moreira, Martina Pecoraro, Jeries Zawaideh, Jelle Barentsz, Francesco Giganti, Anwar R Padhani, Valeria Panebianco, Philippe Puech, Geert Villeirs

Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. ., Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy., Department of Radiology, CH Dunkerque, Dunkirk, France., Department of Radiology, Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal., Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy., Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Imaging Department Andros Clinics, Arnhem, The Netherlands., Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK., Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK., Department of radiology, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille Inserm, CHU Lille, Lille, France., Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium.