Contemporary Prostate Cancer Intraprostatic Imaging Scores: A Practical and Hands-on Guide for Urologists

Prostate cancer (PCa) imaging is increasingly central to diagnosis, staging, and follow-up. Several scoring systems have been proposed to standardize interpretation and facilitate clinical decision-making across modalities. In magnetic resonance imaging (MRI), besides the well-established Prostate Imaging Reporting and Data System score for PCa diagnosis and the Prostate Imaging Quality score for image quality, it is possible to interpret prostate MRI findings using: The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation score in active surveillance, the Prostate Imaging after Focal Ablation or the Transatlantic Recommendations for Prostate Gland Evaluation with MRI After Focal Therapy after focal therapy, or the Prostate Imaging for Recurrence Reporting after prostatectomy or radiotherapy. Beyond MRI, the Prosate Imaging for MRI Instead of Measurements of Aggressive disease in Recurrent/Risk Yields (PRIMARY) scores support prostate-specific membrane antigen-positron emission tomography (PSMA-PET) interpretation, whereas the Prostate Risk Identification using Micro-ultrasound score enables real-time risk assessment and targeted biopsy guidance using the new microultrasound (US) technology. In this mini review, we aim to summarize the current evidence on intraprostatic imaging scoring systems for MRI, PSMA-PET, and US, providing a hands-on guide with practical insights to support their interpretation and routine clinical use. PATIENT SUMMARY: Imaging plays an increasingly important role in prostate cancer management, from diagnosis to treatment planning and follow-up. To help clinicians interpret imaging results consistently, several standardized scoring systems have been developed for intraprostatic imaging. For magnetic resonance imaging, the most used score (Prostate Imaging Reporting and Data System) helps identify suspicious areas that require biopsy to guide biopsy decisions, whereas other scores are used to monitor the disease over time or after treatment. Newer imaging techniques, including prostate-specific membrane antigen-positron emission tomography and microultrasound, also have dedicated scoring systems to standardize reporting. Understanding these tools helps clinicians make more informed decisions and tailor the management of patients.