Magnetic resonance imaging (MRI) is routinely used in prostate cancer diagnosis, but there is uncertainty about its optimal use in population-level screening.
To provide consensus recommendations on the acquisition, interpretation, and reporting of prostate MRI for cancer screening.
A systematic review and meta-analysis of randomized clinical trials and prospective cohort studies evaluating MRI for prostate cancer screening was conducted for these international consensus recommendations. A search of PubMed, CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov, citation searching, and consultation with experts was performed in September 2024. Studies performing upfront MRI for the purpose of prostate cancer screening were included.
A total of 6 studies were identified and included 1919 participants, of whom 1426 underwent upfront screening MRI. Most studies used 3.0-T non-contrast-enhanced MRI. The pooled biopsy recommendation rate was 19.2% (95% CI, 11.7-26.7), with grade group (GG) 2 or higher prostate cancer detection of 6.0% (95% CI, 3.1-9.0) and GG1 cancer detection of 1.4% (95% CI, 0.7-2.2). The positive predictive value for GG2 or higher cancer was 36.3% (95% CI, 21.1-51.4). Findings informed a RAND/UCLA Appropriateness Method consensus exercise used to produce the Prostate Imaging Standards for Screening Magnetic Resonance Imaging (PRISM) recommendations. A total of 21 experts (8 urologists, 11 radiologists, and 2 pathologists from 6 countries) were included on the panel. Among 323 consensus statements, 235 (72.8%) reached agreement. If MRI is used in screening, it is recommended for men with an estimated life expectancy greater than 10 years and aged 50 to 70 years or from age 45 years in Black men. Screening MRI should be performed in men after a prostate-specific antigen (PSA) test, but there was no consensus on the optimal PSA threshold. Non-contrast-enhanced MRI with only T2-weighted and diffusion-weighted imaging was considered appropriate, with a maximum acceptable acquisition time of 15 minutes. The stage-gated (2-step) approach to reporting, where all MRI sequences are only revealed (second step) if a concordant focal lesion is identified on axial T2-weighted and high b-value diffusion imaging (first step), was recommended. Repeat screening should be risk stratified according to patient characteristics. Screening MRI should only be performed in accredited centers with radiologists meeting minimum reporting requirements and quality standards.
The PRISM consensus recommendations provide standardized expert guidance on the use of MRI in prostate cancer screening trials and future screening programs, including abbreviated non-contrast-enhanced MRI protocols, recommended screening intervals, stage-gated reporting, and quality assurance standards.
JAMA oncology. 2026 Jun 11 [Epub ahead of print]
Nikhil Mayor, Alexander Light, Archana Gopalakrishnan, Emma Cullen, Francesca Rawlins, Varsha Sonigra-Patel, Natasha Thorley, Tristan Barrett, Ola Bratt, Tim Dudderidge, Mark Emberton, Francesco Giganti, Aiman Haider, Masoom A Haider, Oliver Hulson, Amish Lakhani, Caroline Moore, Tobias Nordstrom, Anwar R Padhani, Ivo G Schoots, Andrew Smith, Henry Tam, Massimo Valerio, Sadhna Verma, Samuel J Withey, Shonit Punwani, Taimur T Shah, Jan van der Meulen, Hashim U Ahmed
Department of Surgery & Cancer, Imperial College London, London, United Kingdom., Division of Surgery & Interventional Science, University College London, London, United Kingdom., Department of Radiology, University of Cambridge, Cambridge, United Kingdom., Institute of Clinical Sciences, University of Gothenburg, Göteborg, Sweden., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom., Department of Pathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom., Joint Department of Medical Imaging. Sinai Health System, University of Toronto, Toronto, Canada., Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom., Department of Medical Epidemiology and Biostatistics, Karolinska Institute & Dept Clinical Sciences, Danderyd Hospital, Stockholm, Sweden., Paul Strickland Scanner Centre, London, United Kingdom., Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands., North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom., Department of Urology, Geneva University Hospital, Geneva, Switzerland., Department of Radiology, University of Cincinnati, Cincinnati, Ohio., Department of Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom., Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.