Standardizing Prostate MRI Reporting in Active Surveillance for Prostate Cancer: The PRECISE Framework

The rising detection of low-risk localized prostate cancer has established active surveillance (AS) as a standard management approach; however, reliance on repeated biopsies poses procedural risks and patient burden. Multiparametric MRI offers a noninvasive alternative for monitoring disease progression, yet the Prostate Imaging Reporting and Data System has limited capacity in interpreting longitudinal changes. To address this gap, the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) framework was developed to standardize the reporting of serial MRI changes using a 5-point scale, thereby enhancing interpretive consistency, facilitating multidisciplinary communication, and informing timely intervention. The 2024 PRECISE v2 update incorporated standardized imaging quality assessment, refined subcategories for stable disease, quantified progression criteria, and clarified comparison standards, enabling more personalized follow-up strategies. This review synthesizes the development, core features, and clinical implications of PRECISE v1 and v2, highlighting their potential to advance MRI reporting standardization and risk-adapted management in AS for prostate cancer, while outlining key areas for future research.