Advances in prostate cancer imaging: from detection to post-treatment

Advancements in prostate imaging, particularly multiparametric magnetic resonance imaging (mpMRI), have transformed the diagnosis and monitoring paradigms for prostate cancer (PCa). However, considerable interobserver variability has been reported,emphasizing the importance of standardized scoring and reporting systems. The Prostate Imaging Reporting and Data System (PI-RADS), along with quality assurance protocols such as Prostate Imaging Quality (PI-QUAL), has enhanced the diagnostic accuracy of mpMRI. While mpMRI effectively identifies extraprostatic extension, emerging hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) and radio labeled prostate-specific membrane antigen (PSMA) tracers have improved metastasis detection. In active surveillance settings, the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation (PRECISE) recommendations enable the assessment of longitudinal PCa changes. Post-treatment evaluation can also employ dedicated frameworks, such as the Prostate Imaging for Recurrence Reporting (PI-RR) after radical prostatectomy, and either the Prostate Imaging after Focal Ablation (PI-FAB) or the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET). This article reviews key aspects of mpMRI, including structured interpretation frameworks beyond the widely recognized PI-RADS.