PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer
Cameron Englman, Davide Maffei, Clare Allen, Alex Kirkham, Peter C. Albertsen, Veeru Kasivisvanathan, Ronaldo Hueb Baroni, Alberto Briganti, Pieter De Visschere, Louise Dickinson, Juan Gómez Rivas, Masoom A. Haider, Claudia Kesch, Stacy Loeb, Katarzyna J. Macura, Daniel Margolis, Anita Mitra, Anwar R. Padhani, Valeria Panebianco, Peter A. Pinto, Guillaume Ploussard, Philippe Puech, Andrei S. Purysko, Jan Philipp Radtke, Antti Rannikko, Art Rastinehad, Raphaële Renard‐Penna, Francesco Sanguedolce, Lars Schimmöller, Ivo G. Schoots, Shahrokh F. Shariat, Nicola Schieda, Clare M. Tempany, Barış Türkbey, Massimo Valério, Arnauld Villers, Jochen Walz, Tristan Barrett, Francesco Giganti, Caroline M. Moore
Abstract
BACKGROUND AND OBJECTIVE: The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. METHODS: A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1-9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. KEY FINDINGS AND LIMITATIONS: Participants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of 'X' for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). CONCLUSIONS AND CLINICAL IMPLICATIONS: The updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS.