January 19, 2026
How MRI Scoring Helps Detect and Diagnose Prostate Cancer
A PSA blood test is a key part of annual prostate cancer screening for men starting at around age 50. If results repeatedly show elevated PSA levels, your primary care doctor or urologist may recommend imaging tests, such as magnetic resonance imaging (MRI), to examine the prostate more closely.
An MRI is the preferred imaging test because it provides the clearest and most detailed pictures of the prostate. When the radiologist reviews the images, they will include a PI-RADS score in the report. The score will guide future decisions about whether further testing is recommended.
Understanding the PI-RADS Scoring System
The Prostate Imaging Reporting and Data System (PI-RADS) is a standardized scoring system designed to describe findings from prostate MRI scans. This system has greatly improved the diagnosis of prostate cancer by reducing the number of unnecessary biopsies.
To determine the PI-RADS score, a patient first undergoes a specialized type of MRI known as a multiparametric MRI (mpMRI). This type of MRI combines several imaging techniques:
T2-Weighted (T2W) Imaging: This technique allows radiologists to see the prostate's structure and identify any irregular or suspicious areas.
Diffusion-Weighted Imaging (DWI): This method measures how water moves through prostate tissue. Areas where the flow of water is restricted can point to the presence of cancer.
Dynamic Contrast-Enhanced (DCE) Imaging: This imaging technique uses a contrast agent to highlight blood flow through the prostate. Tumors often develop in areas with increased blood supply.
Prostate Morphology: This imaging assesses the overall shape and appearance of the prostate for any abnormalities.
The combination of these imaging methods allows doctors to get a clearer picture of the prostate's condition and look for signs of cancer. The radiology report will include one of the following:
PI-RADS 1: Very low risk; no signs of prostate cancer present
PI-RADS 2: Low risk; prostate cancer is unlikely to be present
PI-RADS 3: Intermediate risk; prostate cancer may or may not be present
PI-RADS 4: High risk; prostate cancer is likely to be present
PI-RADS 5: Very high risk; prostate cancer is highly likely to be present
It’s important to understand that an MRI and PI-RADS score do not directly diagnose prostate cancer. Instead, they help doctors decide whether further testing is necessary. Previously, many men had biopsies even when cancer wasn’t present. Now, a biopsy is typically scheduled only when the PI-RADS score is three or higher.
Do Doctors Use MRI Imaging After a Prostate Cancer Diagnosis?
Yes, MRIs are commonly used after a diagnosis of prostate cancer. Since prostate cancer typically grows slowly, prostate cancer doctors may repeat MRIs periodically to monitor any changes in the cancer. The results of these scans help urologists or oncologists in deciding whether to begin treatment or perform another biopsy.
Additionally, MRIs are used during biopsies. MRI-guided biopsies enable doctors to take accurate samples from the most suspicious areas identified in the images.
Prostate Biopsies: The Ultimate Determining Factor Guided by MRI Technology
During a prostate MRI-guided biopsy, the doctor typically takes 9 to 12 samples from the prostate with the help of the MRI results to determine which areas produced a PI-RADS score. Afterwards, a pathologist examines the samples and provides the results in a pathology report, including the Gleason score.
The pathologist examines the two most common cell patterns found in the samples. This is different from the PI-RADS score from the imaging tests. Each sample is given a score between 1 and 5. A 1 means the cells look normal, and a 5 means the cells are highly abnormal. Adding these two scores together creates the Gleason score. A score of 5 or under is not considered cancer.
Here is a breakdown of elevated Gleason scores:
Gleason 6: Low-grade prostate cancer may be present. Watchful waiting is usually the recommendation at this time. This process monitors the patient every six months or more often to check for changes in cancer growth. A biopsy may be recommended if the Gleason score rises.
Gleason 7: A score of 7 is unique in that the treatment recommendations depend on the specific combinations of scores that result in seven. If the predominant pattern is scored as 3 and the secondary pattern as 4 (3+4), the oncologist may recommend watchful waiting. However, if the score is 4+3, it means the cancer is growing, and treatment may need to start. This is considered intermediate-grade cancer.
Gleason 8, 9, or 10: These scores indicate that the cells look very different from healthy cells and are referred to as poorly differentiated or undifferentiated. Immediate treatment is recommended. This is considered high-grade prostate cancer.
Don’t Forget Regular Prostate Cancer Screening
Regular prostate cancer screenings are essential for early detection. Most men should begin PSA testing around the age of 50. Those with known risk factors that increase their likelihood of developing the disease may need to start screening earlier.
Always tell your doctor about any new symptoms or changes in your health. Remember that elevated PSA levels can be caused by conditions other than cancer, so it's important to undergo proper testing.
Prostate Cancer Specialists in Brevard County, Florida
If you’re newly diagnosed with prostate cancer, it’s a good idea to consult with an oncologist in addition to your urologist. The medical oncologists and radiation oncologists at Cancer Care Centers of Brevard will work closely with you to create a personalized treatment plan for prostate cancer tailored to your specific situation. In some cases, you may be able to delay or avoid removing the prostate.
Most men have some time before treatment must begin. Take the time to evaluate your options and choose a cancer care team you feel most comfortable with. We have several cancer centers located throughout Brevard County, including Melbourne, Merritt Island, Palm Bay, and Rockledge, FL.
Categories: Prostate Cancer