Related Experiment Video
Updated: May 5, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Multicentre validation of the PRECISE scoring system for prostate MRI during active surveillance
Francesco Giganti1,2, Riccardo Leni3, Vinayak Wagaskar4
1Division of Surgery and Interventional Science, University College London, London, UK. f.giganti@ucl.ac.uk.
Objectives:
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations assess radiological change in serial MRI during active surveillance (AS) for prostate cancer. PRECISE 1-2 indicates radiological regression, PRECISE 3 stability, and PRECISE 4-5 progression. Our aim was to test the PRECISE score as a predictive tool for disease progression in a multicentre international setting.
Materials And Methods:
This is a retrospective study in which we collected data from 22 international centres from December 2005 to July 2022, applying two entry criteria: (1) at least two scans (baseline and follow-up); (2) at least two biopsies (baseline and follow-up, the latter after the second scan). Local radiologists reported scans according to PRECISE. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to different biopsy thresholds and definitions of progression were calculated.
Results:
A total of 1667 patients were included. Median follow-up was 4 years (IQR: 2.1-6.3). A total of 1248 (75%) patients underwent two MRIs and immediate subsequent biopsy, 300 (24%) of which had biopsy progression to Grade Group ≥ 2 and 77 (6%) to Grade Group ≥ 3. Patients with PRECISE 4-5 had 4.53-fold increased odds (95% CI: 3.37-6.12; p < 0.001) of biopsy progression compared to PRECISE 1-3. Using a PRECISE ≥ 4 cutoff to perform follow-up biopsies, overall sensitivity, specificity, PPV and NPV were 57%, 79%, 46%, and 85% for the first follow-up scan.
Conclusion:
The PRECISE recommendations could lead to timely identification of patients on AS who progress on MRI, prompting re-biopsy or treatment, and safe reduction of repeat biopsies for those with stable MRI and prostate-specific antigen kinetics.
Key Points:
Question Can the PRECISE scoring system for monitoring prostate cancer lesions on active surveillance on MRI predict disease progression and avoid unnecessary biopsies? Findings The PRECISE score effectively predicts prostate cancer progression, with PRECISE 4-5 (progression) scores indicating 4.53-fold increased odds of biopsy progression compared to PRECISE 1-3 (regression/stability). Clinical relevance This study validates PRECISE as a tool for managing patients on active surveillance. It can help clinicians identify those needing timely re-biopsy or treatment, while reducing unnecessary biopsies in patients with stable disease on imaging and PSA kinetics.
Insights
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) score effectively predicts prostate cancer progression during active surveillance. PRECISE 4-5 scores significantly increase the odds of biopsy progression, aiding in timely intervention and reducing unnecessary biopsies.
Area of Science:
- Oncology
- Radiology
- Urology
Background:
- Active surveillance (AS) for prostate cancer requires reliable methods to monitor disease progression.
- The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system was developed to assess changes on serial MRI scans.
- PRECISE scores range from 1-2 (regression), 3 (stability), to 4-5 (progression).
Purpose of the Study:
- To evaluate the PRECISE score's effectiveness in predicting disease progression in a multicenter international cohort of prostate cancer patients undergoing active surveillance.
- To determine the diagnostic performance of the PRECISE score in identifying patients who require re-biopsy or treatment.
Main Methods:
- Retrospective analysis of data from 1667 patients across 22 international centers (December 2005 - July 2022).
- Inclusion criteria: at least two MRI scans (baseline and follow-up) and two biopsies (baseline and follow-up, post-second scan).
- Local radiologists assessed MRI scans using the PRECISE system; sensitivity, specificity, PPV, and NPV were calculated based on biopsy outcomes.
Main Results:
- Patients with PRECISE 4-5 scores had a 4.53-fold increased odds of biopsy progression (Grade Group ≥ 2) compared to those with PRECISE 1-3 scores (p < 0.001).
- For predicting progression using a PRECISE ≥ 4 cutoff on the first follow-up scan, sensitivity was 57%, specificity 79%, PPV 46%, and NPV 85%.
- A total of 1667 patients were included, with a median follow-up of 4 years; 24% experienced biopsy progression to Grade Group ≥ 2.
Conclusions:
- The PRECISE scoring system is a valuable tool for predicting prostate cancer progression in patients on active surveillance.
- Utilizing PRECISE scores can facilitate timely identification of patients needing re-biopsy or treatment.
- The PRECISE system may allow for the safe reduction of repeat biopsies in patients with stable MRI findings and PSA kinetics.
Related Concept Videos
01:27Imaging Studies IV: Magnetic Resonance Imaging
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT