High-quality evidence shows that MRI in biopsy-naive men can reduce the number of men who need prostate biopsy and can reduce the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm. In men with prior negative biopsy results who remain under persistent suspicion, MRI improves the detection and localization of life-threatening prostate cancer with greater clinical utility than the current standard of care, systematic transrectal US-guided biopsy. Systematic analyses show that MRI-directed biopsy increases the effectiveness of the prostate cancer diagnosis pathway. The incorporation of MRI-directed pathways into clinical care guidelines in prostate cancer detection has begun. The widespread adoption of the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric MRI data acquisition, interpretation, and reporting has promoted these changes in practice. The PI-RADS MRI-directed biopsy pathway enables the delivery of key diagnostic benefits to men suspected of having cancer based on clinical suspicion. Herein, the PI-RADS Steering Committee discusses how the MRI pathway should be incorporated into routine clinical practice and the challenges in delivering the positive health impacts needed by men suspected of having clinically significant prostate cancer.

Radiology. 2019 Jun 11 [Epub ahead of print]

Anwar R Padhani, Jelle Barentsz, Geert Villeirs, Andrew B Rosenkrantz, Daniel J Margolis, Baris Turkbey, Harriet C Thoeny, Katarzyna J Macura, Clare M Tempany, Sadhna Verma, Jeffrey C Weinreb

From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.).