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Review
. 2025 Jul 1;35(4):418-425.
doi: 10.1097/MOU.0000000000001288. Epub 2025 Apr 23.

The prognostic role of prostate MRI in prostate cancer patients

Paolo Zaurito  1   2 , Armando Stabile  1 , Francesco Montorsi  1   2 , Alberto Briganti  1   2 , Giorgio Gandaglia  1   2
Affiliations
Review

The prognostic role of prostate MRI in prostate cancer patients

Paolo Zaurito et al. Curr Opin Urol. .

Abstract

Purpose of review: Multiparametric MRI (mpMRI) has been included in the diagnostic pathway of prostate cancer (PCa). However, the role of this imaging modality in predicting clinical outcomes after diagnosis has been poorly addressed so far. This review aims to summarize the most relevant updates on the prognostic role of mpMRI.

Recent findings: Baseline mpMRI features help to predict adverse pathology at radical prostatectomy (RP) and grade reclassification during active surveillance. Parameters derived at prostate mpMRI such as PI-RADS score 4-5, the maximum diameter of the index lesion and the presence of extracapsular invasion/seminal vesicle invasion are among the strongest predictors of biochemical recurrence (BCR) for men treated with RP. mpMRI-based predictive models can achieve similar accuracy for BCR prediction when compared with validated models that relied on final pathology. Moreover, the use of mpMRI findings to predict disease recurrence after radiotherapy or focal therapy seems to optimize patient's risk stratification after treatment, ruling out disease recurrence.

Summary: Clinicians should account for prostate mpMRI findings when predicting clinical outcomes in patients diagnosed with PCa.

Keywords: Prostate Imaging-Reporting and Data System; adverse outcomes; biochemical recurrence; multiparametric MRI; prognosis; prostate cancer.

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