Prostate MRI reporting and its impact on clinical decision-making: the urologists' perspective

Multiparametric MRI (mpMRI) has fundamentally changed the diagnostic and management pathways for prostate cancer (PCa). Its clinical utility depends not only on image quality and interpretative accuracy but also on the completeness and precision of the radiological report. This review synthesizes the available evidence across five key reporting domains that directly impact clinical decision-making: (1) pre-biopsy triage, including Prostate Imaging Reporting and Data System (PI-RADS) scoring and Prostate Imaging Quality (PI-QUAL) assessment; (2) prostate volume measurement and PSA density (PSAD) reporting; (3) local staging, with particular emphasis on extraprostatic extension (EPE) and seminal vesicle invasion (SVI); (4) regional lymph node assessment, and (5) serial MRI monitoring using the PRECISE v2 framework for men undergoing active surveillance. Evidence from randomised controlled trials, large cohort studies, meta-analyses, and clinical practice guidelines published up to March 2026 was synthesised, with priority given to the highest level of available evidence and current European Association of Urology guidance. For each domain, we define the core reporting elements and discuss the evidence supporting their clinical relevance from both radiological and urological perspectives. Across all five domains, the clinical value of prostate MRI depends as much on complete and standardised reporting as on the quality of image acquisition and interpretation.