Dr. Kastner began by highlighting the structure of a medical system – while this will inevitably vary from system to system, there is without a doubt a role of primary care, teaching, and non-teaching specialty groups, tertiary and quaternary care centers of excellence, as well as many other practice environments. Patients will undoubtedly need to seek care across this spectrum. A categorization of “community” and “expert” centers misses much of the nuance in actual practice. Understanding the information necessary from an MRI may help guide how we assess MRI interpretation. Most would agree, as Dr. Kastner highlighted, that urologists are looking for a reliable and informative negative predictive value, high levels of cancer detection in lesions deemed PiRADS 5, low rates of equivocal findings in PIRADS 3 lesions, and accurate TNM staging.
First, it may be helpful to consider variability in the protocol of MRI performed, including the sequences that are utilized. Dr. Kastner presented an example from East Anglia highlighting significant variation between centers, as of 2014: 
Beyond the technical aspects of performing MRI, interpretation is key. A number of studies of which he highlighted two have demonstrated that interpretation by prostate MRI experts increases the utility of prostate MRI, decreasing equivocal findings, increasing detection rates of clinically significant disease, and increasing the negative predictive value for excluding clinically significant disease. 
While it is not reasonable to expect that every patient undergoing prostate MRI will receive care at a center of excellence, there are numerous efforts underway at regional, national and international levels to ensure that there is a widespread quality standard that is being met. PIRADS is perhaps the best known of these though other education, credentialing, and QI standards are also contributory.
On the basis of a structured interpretation report, the use of template improved prostate MRI reports in terms of valid TNM staging from 5.4% to 97.8%.
Dr. Kastner highlighted that data-driven quality improvement is relatively straightforward using a correlation between radiologic interpretation and histopathology. Key to this is a systematic and reproducible biopsy strategy.
Highlighting one of many studies, Dr. Kastner emphasized that volume (both in terms of radiographic interpretation and biopsy) is important to provide high-quality outcomes.
In closing, he highlighted the importance of teamwork along with standardized imaging, biopsy, and pathology. This can occur in any practice setting assuming that all are engaged in the process.
Presented by: Christof Kastner, PhD, FRCS (Urol), FEBU, Addenbrooke's Hospital, Cambridge
Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center at the 35th Annual EAU Congress, 2020 Virtual Program #EAU20, July 17-19, 2020.