PI-RADS v2.1 Assessment
Lesion Characteristics
Awaiting Sequences
Select the lesion location and provide the required mpMRI sequence scores to calculate the PI-RADS category.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
When to Use PI-RADS v2.1
Multiparametric prostate MRI (mpMRI) in biopsy-naïve men with elevated PSA or abnormal digital rectal exam (DRE)
Prior negative systematic biopsy with persistent clinical suspicion of prostate cancer
Active surveillance of low-risk prostate cancer to detect progression
Staging of known prostate cancer (local extent, extraprostatic extension, seminal vesicle invasion)
Preoperative planning for radical prostatectomy or focal therapy
Post-treatment assessment in select cases (though not primary indication for v2.1)
Risk stratification to guide targeted biopsy vs systematic biopsy vs surveillance
Definition of Clinically Significant Prostate Cancer (csPCa)
For PI-RADS v2.1 purposes, csPCa is defined as:
• Gleason score ≥ 7 (ISUP Grade Group ≥ 2), including 3+4 with prominent Gleason 4 component
• AND/OR tumor volume > 0.5 cm³
• AND/OR extraprostatic extension (EPE)
Patient Preparation and Technical Requirements
3T scanner preferred (1.5T acceptable with endorectal coil in some cases)
No endorectal coil required at 3T for diagnostic quality
Interval of at least 6 weeks after prostate biopsy to minimize hemorrhage artifact
Antispasmodics (e.g., glucagon) to reduce bowel motion artifact
Multiparametric protocol: T2-weighted (T2W), Diffusion-weighted imaging (DWI) with ADC map, Dynamic contrast-enhanced (DCE)
High b-value DWI (≥1400 s/mm²) mandatory
Related Scores in Practice
In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Ipss, Psa Density, Bph Impact Index, or the Aast Renal Injury Scale to formulate a comprehensive care plan.
Last Comprehensive Review: 2026