PRECISE v2 in active surveillance prostate MRI: toward a structured lexicon for longitudinal interpretation

Active surveillance increasingly incorporates prostate MRI for longitudinal assessment of lesion stability or progression, yet terminology for serial interpretation remains less standardized than in the diagnostic setting. PRECISE version 2 (v2) provides an updated framework for evaluating interval MRI change during active surveillance, incorporating lesion-level and technical descriptors, stable visible and stable non-visible disease, and the non-assessable category PRECISE X. This review intends to present a practical pictorial atlas of standardized terminology for prostate MRI during active surveillance, grounded in PRECISE v2 and informed by broader principles of radiologic lexicon development. In particular, it extends terminology standardization by organizing descriptors according to context of use, distinguishing broadly applicable prostate MRI terms from those specific to serial active-surveillance interpretation. Key descriptors are grouped into lesion identification and visibility, morphologic features, functional features, and technical adequacy, and their relationship to PRECISE score assignment is reviewed. The review also addresses integration of this lexicon into structured reporting, multidisciplinary communication, education, and future research and artificial intelligence applications. A practical PRECISE-based lexicon may improve consistency of MRI interpretation during active surveillance, reduce ambiguity in communication, and support more reproducible MRI-guided surveillance across clinical practice and research.