MRI for Prostate Cancer Local Staging: AJR Expert Panel Narrative Review

The incremental value of multiparametric MRI (mpMRI) in prostate cancer staging has been increasingly recognized, with the accumulated literature indicating a central role of MRI findings not only in detecting cancer but also in guiding local and systemic management. However, despite growing adoption of mpMRI for prostate cancer staging, no universally accepted framework for MRI-based staging exists. Additionally, proposed scoring systems for extraprostatic extension (EPE) remain outside of the PI-RADS structure, and reproducibility of MRI-based staging across centers is variable. This AJR Expert Panel Narrative Review synthesizes current evidence on the use of mpMRI for prostate cancer local staging, highlights key MRI features that help distinguish organ-confined disease from tumors associated with EPE or seminal vesicle invasion, and considers such findings' implications for surgery and radiotherapy planning. Proposed structured frameworks for EPE reporting, based on MRI findings alone or MRI in combination with clinical parameters, are explored. Ongoing challenges and unmet needs are emphasized, including lack of reporting standardization, variable integration of mpMRI into international staging guidelines, and the need for prospective studies to validate the role of mpMRI staging in multidisciplinary prostate cancer care. Finally, potential future impacts of radiomics, artificial intelligence, and molecular imaging are considered.