Prostate MRI programme

The pathway is only as reliable as the acquisition and feedback loop.

Clinical use cases are paired with the technical, reporting and quality requirements in the CAR white paper.

Clinical use case

Choose the question the MRI is being asked to answer.

Minimum acquisition guardrails

Local optimization is expected, but the examination must satisfy the diagnostic task.

Magnet: 3 T whenever possible; optimized 1.5 T is acceptable. Imaging below 1.5 T is not recommended.
Coil: an endorectal coil is not routinely necessary; it may help when surface-coil SNR is inadequate in a large patient.
Standard mpMRI: T2 in axial plus sagittal/coronal, T1, DWI/ADC and DCE.
DWI: low b 50–100, intermediate b 800–1000 and high b >1400 s/mm² (acquired or calculated).
DCE: 3D T1 gradient echo, temporal resolution ≤15 seconds.
bpMRI: only at radiologist discretion in centres that have demonstrated local performance comparable to mpMRI; use contrast after treatment.

Programme QA that must exist behind the report

The white paper treats reader and system performance as patient-safety requirements.

Report image quality; review 10 consecutive representative cases every 6 months against PI-RADS technical standards.
Use PI-RADS v2.1 structured/hybrid reporting; include age, PSA and indication.
Before independent interpretation, complete appropriate training and 50 histology-confirmed cases.
Use double reading for limited/preliminary expertise or low volumes.
Build histopathology feedback and multidisciplinary review into performance audit.

Reference guidance · Diagnostic pathway

Use mpMRI before biopsy when the patient is a curative-treatment candidate.

CAR supports the Cancer Care Ontario recommendation, endorsed by the Canadian Urological Association, for suspected clinically localized prostate cancer.

Practical pathway

Confirm the patient is at elevated risk of clinically significant prostate cancer and is a candidate for curative management.
Perform quality-assured prostate mpMRI before biopsy.
Use the MRI result with PSA, age and clinical risk—not PI-RADS in isolation—to determine the biopsy plan.
If biopsy is pursued, ensure suspicious MRI targets can be accurately transferred to the biopsy operator.

Do not overstate

The CAR white paper establishes a programme-quality standard; it does not provide a stand-alone risk calculator or a universal PI-RADS-to-biopsy mandate.
A negative MRI does not eliminate clinically significant cancer in every pretest-risk group.

Open CAR prostate MRI white paper ↗

CAR 2022 · reaffirmed 2026PI-RADS v2.1 in source

Evidence register

What governs this draft

Dated primary sources and their role in this draft.

Recommendation wording is condensed for point-of-care use. The dated primary source remains authoritative and must be rechecked before publication or institutional adoption.

CAR Prostate MRI White PaperCanadian Association of Radiologists Prostate MRI White PaperPublished 2022 · reaffirmed June 2026

Patient pathway, acquisition, structured reporting, training, QA and targeted-biopsy programme recommendations.

Open source ↗