Multiparametric MRI prostate for cancer detection, staging and active surveillance — with PI-RADS v2.1 compliant reporting by subspecialist consultants.
Prostate cancer is the most common cancer in men in the UK. For many years, diagnosis relied on PSA blood tests and systematic (random) biopsy — an approach that missed significant cancers while over-detecting clinically insignificant ones. Multiparametric MRI (mpMRI) has transformed this landscape.
Large clinical trials, including PRECISION and PROMIS, have demonstrated that performing MRI before biopsy improves the detection of clinically significant cancer while reducing unnecessary biopsies. The NICE guidelines now recommend mpMRI before biopsy in most men with a raised PSA.
mpMRI combines multiple imaging sequences — T2-weighted imaging, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging — to produce a comprehensive assessment of the prostate gland. Areas of concern are scored using the internationally standardised PI-RADS (Prostate Imaging-Reporting and Data System) scale.
| PI-RADS 1 | Very low — clinically significant cancer highly unlikely |
| PI-RADS 2 | Low — clinically significant cancer unlikely |
| PI-RADS 3 | Intermediate — equivocal |
| PI-RADS 4 | High — clinically significant cancer likely |
| PI-RADS 5 | Very high — clinically significant cancer highly likely |
Men with a raised PSA (including age-specific thresholds) should be offered mpMRI before biopsy, in line with NICE guidelines. MRI helps identify which men have a lesion that warrants targeted biopsy.
mpMRI performed before prostate biopsy allows targeted, MRI-guided biopsy of suspicious lesions — increasing the detection of clinically significant cancer and reducing the number of unnecessary cores needed.
Men on active surveillance for low or intermediate risk prostate cancer should have periodic mpMRI to monitor for disease progression as part of their surveillance protocol.
Men with a persistently elevated PSA despite a previously negative biopsy benefit from mpMRI before re-biopsy. MRI can identify areas not sampled by systematic biopsy.
In men with known prostate cancer, mpMRI provides local staging information — assessing extracapsular extension, seminal vesicle involvement and lymph node status.
MRI can assess for local recurrence after radical prostatectomy or radiotherapy, and guide management decisions in cases of biochemical recurrence.
You will be asked to avoid ejaculation for 3 days before your scan and, ideally, to take a micro-enema (Micralax) 1–2 hours before the scan to empty the rectum. A full bladder can also improve image quality — you will be given specific instructions. If you have had a biopsy recently, we prefer to wait at least 6–8 weeks for haematoma to resolve before performing MRI.
The scan takes approximately 30–45 minutes. You will lie on your back on the MRI table. Some protocols use an antiperistaltic agent (Buscopan) to reduce bowel movement and gadolinium contrast to assess vascularity of any lesion. You may be asked to briefly hold your breath. The scanner makes loud knocking sounds — ear protection is provided.
We do not routinely use an endorectal coil at Bristol Medical Imaging. Our modern high-field MRI scanners with body array coils produce high quality images without the discomfort associated with endorectal coils.
Your MRI is reported using the PI-RADS v2.1 framework. The report describes findings sector by sector, assigns a PI-RADS score to any lesion, and provides a clear overall impression and recommendation. Reports are typically available within 24–48 hours and sent to your referring clinician.