The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations assess radiological change in serial MRI during active surveillance (AS) for prostate cancer. PRECISE 1-2 indicates radiological regression, PRECISE 3 stability, and PRECISE 4-5 progression. Our aim was to test the PRECISE score as a predictive tool for disease progression in a multicentre international setting.
This is a retrospective study in which we collected data from 22 international centres from December 2005 to July 2022, applying two entry criteria: (1) at least two scans (baseline and follow-up); (2) at least two biopsies (baseline and follow-up, the latter after the second scan). Local radiologists reported scans according to PRECISE. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to different biopsy thresholds and definitions of progression were calculated.
A total of 1667 patients were included. Median follow-up was 4 years (IQR: 2.1-6.3). A total of 1248 (75%) patients underwent two MRIs and immediate subsequent biopsy, 300 (24%) of which had biopsy progression to Grade Group ≥ 2 and 77 (6%) to Grade Group ≥ 3. Patients with PRECISE 4-5 had 4.53-fold increased odds (95% CI: 3.37-6.12; p < 0.001) of biopsy progression compared to PRECISE 1-3. Using a PRECISE ≥ 4 cutoff to perform follow-up biopsies, overall sensitivity, specificity, PPV and NPV were 57%, 79%, 46%, and 85% for the first follow-up scan.
The PRECISE recommendations could lead to timely identification of patients on AS who progress on MRI, prompting re-biopsy or treatment, and safe reduction of repeat biopsies for those with stable MRI and prostate-specific antigen kinetics.
Question Can the PRECISE scoring system for monitoring prostate cancer lesions on active surveillance on MRI predict disease progression and avoid unnecessary biopsies? Findings The PRECISE score effectively predicts prostate cancer progression, with PRECISE 4-5 (progression) scores indicating 4.53-fold increased odds of biopsy progression compared to PRECISE 1-3 (regression/stability). Clinical relevance This study validates PRECISE as a tool for managing patients on active surveillance. It can help clinicians identify those needing timely re-biopsy or treatment, while reducing unnecessary biopsies in patients with stable disease on imaging and PSA kinetics.
European radiology. 2026 May 04 [Epub ahead of print]
Francesco Giganti, Riccardo Leni, Vinayak Wagaskar, Giorgio Gandaglia, Tristan Barrett, Valeria Panebianco, Francesco Sanguedolce, Erik Jrj van der Hoeven, Sangeet Ghai, Jeremy Grummet, Jasmin Gmeiner, Jan Philipp Radtke, Ryan D Ward, Ronaldo Hueb Baroni, Francesco Porpiglia, Juan Gomez Rivas, Fabio Zattoni, Raphaële Renard-Penna, Claudia Kesch, Marco Gatti, Nicola Schieda, Guillaume Ploussard, Sara Lewis, Giorgio Brembilla, Christof Kastner, Emanuele Messina, Ash Tewari, Caroline M Moore, Massimo Valerio, Armando Stabile, Veeru Kasivisvanathan, Young Academic Urologists Active Surveillance Initiative
Division of Surgery and Interventional Science, University College London, London, UK. ., Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain., Department of Radiology, St Antonius Hospital, Utrecht, The Netherlands., Joint Department of Medical Imaging, University Health Network-Mt Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, ON, Canada., Department of Surgery, Alfred Health, School of Translational Medicine, Monash University, Melbourne, Australia., Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria., Department of Urology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany., Abdominal Imaging Section, Diagnostics Institute, Cleveland Clinic, Cleveland, OH, USA., Imaging Section, Hospital Israelita Albert Einstein, Sao Paulo, Brazil., Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy., Department of Urology, Health Research Institute, Hospital Clinico San Carlos, Madrid, Spain., Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy., Department of Imaging, Hôpital Pitié Salpêtrière APHP-Sorbonne University, Paris, France., Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany., Division of Radiology, Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy., Department of Radiology, The University of Ottawa, Ottawa, ON, Canada., La Croix du Sud Hospital, Department of Urology, Quint-Fonsegrives, France., Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., Division of Surgery and Interventional Science, University College London, London, UK., Department of Urology, Lausanne University Hospital, Lausanne, Switzerland.