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

Objectives To characterise contemporary UK practice in prostate MRI reporting and pathways, and identify priorities for standardisation. 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 77 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%). 100% of Trusts 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 = 0.023) Conclusions This survey shows the current state of UK prostate MRI practice, including universal pre-biopsy MRI. It identifies areas for standardisation, including MRI protocols, scoring systems, and national staging guidelines. Advances in Knowledge Provides an up-to-date snapshot on prostate MRI within the UK.