Prostate MRI in the United Kingdom: a survey of current practice by the British Society of Urogenital Radiology

Objectives: To characterize contemporary UK practice in prostate MRI reporting and pathways, and identify priorities for standardization. Methods: Between February and April 2025, a questionnaire was distributed by the British Society of Urogenital Radiology to UK-based consultant radiologists who report prostate MRI. It contained 34 questions, covering 6 domains: demographics; MRI protocols; biopsy; reporting preferences; imaging pathways; and attitudes towards accreditation. Results: Seventy-seven radiologists representing 52 NHS Trusts across all nations of the UK responded. Key findings include variable patient preparation for MRI including anti-spasmodic medication (69.2% administering) and instruction related to bowel preparation (13.5%). Trusts (100) were performing MRI prior to biopsy for suspected cancer; 73.1% using multiparametric MRI. When reporting prostate MRI for suspected cancer, 28.6% document only a PI-RADS score, 27.3% only a Likert score, with 44.1% stating both. The PI-QUAL score is moderately well known (71.4% of respondents) but not in routine use (7.8%). Transperineal prostate biopsy was performed at 88.5% of Trusts, with biopsy more likely to be performed by urologists (98.1% of Trusts) or urology nurses (36.5%) than radiologists (26.9%). Patients with high- or very high-risk prostate cancer undergo variable staging pathways, with university teaching hospitals more likely to offer PSMA PET/CT than other settings (33.3% vs 12.0%, P = .023). Conclusions: This survey shows the current state of UK prostate MRI practice, including universal pre-biopsy MRI. It identifies areas for standardization, including MRI protocols, scoring systems, and national staging guidelines. Advances in knowledge: Provides an up-to-date snapshot on prostate MRI within the UK.