How to cite: Verma SM. “Prostate MRI Update — What’s New on the Horizon?” October, 2025. Accessed Oct 2026. https://grandroundsinurology.com/prostate-mri-update-whats-new-on-the-horizon/
Summary
Sadhna Verma, MD, MBA, FSAR, Adjunct Professor of Radiology, Radiation Oncology and Urology, Director of Prostate Imaging Program, Director of the Prostate Cancer Imaging Program, Cincinnati VAMC and University of Cincinnati, Cincinnati, Ohio, presents an overview of the current state of prostate magnetic resonance imaging (MRI). She states that pre-biopsy MRI is now widely established as the standard of care. Prostate imaging reporting and data system (PI-RADS) version 2.1 remains the structured reporting framework in routine use. Multiple validation studies confirm that the PI-RADS v2.1 transition zone upgrading rules, specifically the two plus one and three plus one categories, accurately reflect the likelihood of clinically significant prostate cancer. A meta-analysis including more than 1,500 transition zone lesions supports improved categorization when diffusion-weighted imaging upgrades are applied.
Dr. Verma reviews emerging prostate MRI scoring systems. Prostate Imaging Quality (PI-QUAL) evaluates the image quality. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) guides longitudinal follow-up for active surveillance. Prostate Imaging for Recurrence Reporting (PI-RR) characterizes findings in the setting of recurrence. The Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) and Prostate Imaging after Focal Ablation (PI-FAB) outline a structured assessment following focal therapy. She also notes advances in coil engineering, with high-channel phased array coils improving signal quality at both 3 Tesla and modern 1.5 Tesla systems.
She focuses on artificial intelligence, particularly deep learning reconstruction. These algorithms enhance sharpness, signal-to-noise ratio, and contrast-to-noise ratio, while also reducing acquisition times. Dr. Verma notes that hallucination artifacts and over-smoothing can occur and vary with vendor, reconstruction strength, and scanner configuration, creating variable effects on computer-aided detection algorithms.
She reviews risk-adapted screening strategies that integrate MRI with blood-based triage tools such as the Stockholm3 model. European guidelines now include MRI within population-based screening pathways. She explains how MRI, combined with prostate-specific antigen (PSA) density, informs biopsy decisions for PI-RADS three lesions. Biparametric and abbreviated MRI demonstrate feasibility for active surveillance when quality control is maintained.
Dr. Verma emphasizes the importance of accuracy in lesion mapping for focal therapy planning, discussing examples in which dynamic contrast enhancement reveals a greater lesion extent than initially appreciated on T2-weighted or diffusion sequences. She highlights anticipated developments in quantitative apparent diffusion coefficient (ADC), radiomics, and real-world artificial intelligence evaluation, while reinforcing that quality assurance programs remain essential.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.
ABOUT THE AUTHOR
Sadhna Verma, MD, MBA, FSAR, is an Adjunct Professor-Affiliate of Radiology at the University of Cincinnati in Ohio. Dr. Verma established and continues to serve as the Director of the Prostate MRI Program at the University of Cincinnati and established the university’s CT imaging program for CT Urography and CT Enterography. Dr. Verma is the associate Chair of Quality and Performance Improvement at the Prostate Cancer Midwest Center of Excellence and the Director of the Prostate Cancer Imaging Program for the U.S. Department of Veterans Affairs. She is an international expert in the fields of GI and GU Imaging.
Dr. Verma earned her medical degree from the University of Louisville in Kentucky. She then completed an internship in Internal Medicine at the University of Pittsburgh in Pennsylvania. Dr. Verma completed a residency in Diagnostic Radiology and a fellowship in Health Service and Outcomes Research at the University of Cincinnati and then completed a fellowship in Body Imaging/3D Imaging at Johns Hopkins University in Baltimore, Maryland. Dr. Verma earned her MBA from the University of Chicago Booth School of Business in Illinois.
Dr. Verma is a member of the International Prostate MRI Working Group. She conducts local and national workshops to help train radiologists and inform clinicians and patients about this test. Dr. Verma has over 100 published articles and book chapters in her field.
