Optimizing Multiparametric MRI Protocols for Prostate Cancer Detection: A Comprehensive Assessment Aligned with PI-RADS Guidelines

Background and Aim: Multiparametric magnetic resonance imaging (mpMRI) is recognized as the most indicative method for diagnosing prostate cancer. The purpose of this narrative review is to provide a comprehensive evaluation aligned with the Prostate Imaging and Reporting Data System (PI-RADS) guidelines, offering an in-depth insight into the various MRI sequences used in a standard mpMRI protocol. Additionally, it outlines the critical technical requirements necessary to perform a standard mpMRI examination of the prostate, as defined by the PI-RADS specifications. Methods: European Society of Urogenital Radiology has released PI-RADS guideline detailing its suggestions aimed at improving the standards of the procedure. The purpose of this guideline is to establish a standard strategy for MRI protocols and image interpretation, aiming to prevent variability in each of the imaging and interpretation stages. Results: A standard mpMRI protocol comprises morphological sequences and functional sequences. Morphological sequences which encompass T1- and T2-weighted images, and various functional sequences include diffusion-weighted imaging, and dynamic contrast-enhanced MRI. The PI-RADS recommendations assert that having a standard and uniform protocol for all MRI centers is imperative. Furthermore, the existence of a standardized checklist for interpreting MRI images can foster greater consensus in the process of diagnosing and treating patients. Conclusion: Standardized protocols and checklists for mpMRI interpretation are essential for achieving greater consensus among radiologists, ultimately leading to improved diagnostic outcomes in prostate cancer.