Editing AUA: Early Detection of Prostate Cancer (2023) (section)

=== Prostate MRI before biopsy ===
*'''<span style="color:#ff0000">MRI may be used prior to initial biopsy to increase the detection of GG2+ prostate cancer</span>'''
** Studies have demonstrated the clinical value of mpMRI and using this to guide biopsy decision-making can increase the likelihood of detecting clinically significant prostate cancer while lowering detection of insignificant disease. This is particularly true in patients with a prior negative prostate biopsy; data from patients who are biopsy naïve are less definitive.
** While some data suggest the benefit of a prebiopsy MRI in biopsy-naïve patients, conflicting reports moderate the enthusiasm for a strong recommendation.
** It is reasonable to obtain an mpMRI in biopsy-naïve patients prior to their first biopsy, but such a practice cannot be regarded as the standard approach based on the currently available evidence.
* '''Radiologists should utilize PI-RADS in the reporting of mpMRI imaging.'''
** '''<span style="color:#ff0000">Detection rates by PI-RADS score for</span>''' 
***'''Any prostate cancer'''
****'''PR 1-2: 15%'''
**** '''PR 3: 25%'''
**** '''PR 4: 58%'''
**** '''PR 5: 85%'''
***'''<span style="color:#ff0000">GG2+ prostate cancer</span>'''
****'''<span style="color:#ff0000">PR 1-2: 7%</span>'''
**** '''<span style="color:#ff0000">PR 3: 11%</span>'''
**** '''<span style="color:#ff0000">PR 4: 37%</span>'''
**** '''<span style="color:#ff0000">PR 5: 70%</span>'''
***Of the 23 studies that were pooled for these results, 10 reported on a per lesion analysis and 13 reported on a per patient analysis using an index lesion.
** '''Reader variability remains a challenge'''