THE PRECISE score may help clinicians identify radiological change on MRI associated with biopsy progression during active surveillance for prostate cancer, according to data from an international multicentre study involving 1,667 patients.
Patients with low-risk or favourable intermediate-risk disease are often offered active surveillance, a strategy that monitors cancer closely to avoid unnecessary treatment and treatment-related side effects while preserving the opportunity for curative intervention if the disease worsens.
Researchers evaluated the performance of the PRECISE score, an MRI-based reporting system designed to standardise assessment of radiological change during active surveillance.
PRECISE scores range from 1 to 5, with scores of 1-2 indicating regression, 3 indicating stability, and 4-5 suggesting radiological progression.
MRI Changes Corresponded with Biopsy Progression
The retrospective study collected data from 22 international centres between December 2005 and July 2022. Eligible patients had undergone at least two MRI scans and two biopsies, including a follow-up biopsy performed after the second scan.
Researchers assessed whether radiological change on MRI, measured using PRECISE scoring, corresponded with biopsy progression during active surveillance.
Median follow-up was four years. Nearly half of patients underwent three or more MRI scans during surveillance, with a median interval of 13 months between baseline and first follow-up MRI.
Among the cohort, 62% of patients had stable MRI findings categorised as PRECISE 3, while 27% showed radiological progression with PRECISE 4-5 scores. Radiological regression was reported in 11% of patients.
Of the 1,248 patients who underwent biopsy immediately after their first follow-up MRI, 24% experienced progression to Grade Group 2 or higher, while 6% progressed to Grade Group 3 or higher.
Patients with PRECISE 4-5 scores had 4.53-fold higher odds of biopsy progression compared with those scoring PRECISE 1-3.
Potential to Reduce Repeat Biopsies
Using a PRECISE threshold of 4 or higher to trigger follow-up biopsy produced a sensitivity of 57%, specificity of 79%, positive predictive value of 46%, and negative predictive value of 85% at the first follow-up scan.
The findings suggest MRI-based PRECISE assessment could support more selective biopsy strategies during active surveillance. Stable MRI findings alongside prostate-specific antigen kinetics may help identify patients who can safely avoid repeat biopsy, while radiological progression could prompt earlier re-biopsy or treatment consideration.
However, the study was retrospective, and the performance metrics indicate that MRI changes alone would miss a proportion of biopsy progression cases.
Reference
Giganti F et al. Multicentre validation of the PRECISE scoring system for prostate MRI during active surveillance. Eur Radiol. 2026;DOI: 10.1007/s00330-026-12570-z.
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