MRI for Prostate Cancer Local Staging: AJR Expert Panel Narrative Review.

Journal: AJR. American journal of roentgenology
Published Date: Jul 1, 2026

Abstract

The incremental value of multiparametric MRI (mpMRI) in prostate cancer staging has been increasingly recognized, with the accumulated literature indicating a central role of MRI findings not only in detecting cancer but also in guiding local and systemic management. However, despite growing adoption of mpMRI for prostate cancer staging, no universally accepted framework for MRI-based staging exists. Additionally, proposed scoring systems for extraprostatic extension (EPE) remain outside of the PI-RADS structure, and reproducibility of MRI-based staging across centers is variable. This AJR Expert Panel Narrative Review synthesizes current evidence on the use of mpMRI for prostate cancer local staging, highlights key MRI features that help distinguish organ-confined disease from tumors associated with EPE or seminal vesicle invasion, and considers such findings' implications for surgery and radiotherapy planning. Proposed structured frameworks for EPE reporting, based on MRI findings alone or MRI in combination with clinical parameters, are explored. Ongoing challenges and unmet needs are emphasized, including lack of reporting standardization, variable integration of mpMRI into international staging guidelines, and the need for prospective studies to validate the role of mpMRI staging in multidisciplinary prostate cancer care. Finally, potential future impacts of radiomics, artificial intelligence, and molecular imaging are considered.

Authors

  • Jorge Abreu-Gomez
    Department of Medical Imaging, University of Toronto. University Medical Imaging Toronto. University Health Network, Mount Sinai Hospital and Women's College Hospital. 610 University Avenue, Suite 3-920. Toronto, ON M5G 2M9, Canada.
  • Steven C Eberhardt
    Professor, Vice Chair for Clinical Operations, Chief, Abdominal and Oncologic Radiology, Department of Radiology, University of New Mexico School of Medicine, UNM Health Sciences Center, Albuquerque, NM, USA.
  • Brian F Chapin
    Professor, Department of Urology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA.
  • Fiona M Fennessy
    Department of Radiology, Mass General Brigham, Boston, MA, USA.
  • Devaki Shilpa Surasi
    Associate Professor, Patient Safety and Quality Officer, Department of Nuclear Medicine, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX, USA.
  • Emily S Weg
    Department of Radiation Oncology, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Radiation Oncology, University of Washington, Seattle, Washington.
  • Haiyi Wang
    Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China.
  • Antonio C Westphalen
    Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA. [email protected].

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