The Prostate Cancer Radiological Estimation of Change in sequential Evaluation (PRECISE) recommendations were published in 2016 to standardize the reporting of MRI examinations performed to assess for disease progression in patients on active surveillance (AS) for prostate cancer. Although a limited number of studies have reported outcomes from use of PRECISE in clinical practice, the available studies have demonstrated PRECISE to have high pooled NPV but low pooled PPV for predicting progression. Our experience in using PRECISE in clinical practice at two teaching hospitals has highlighted issues with its application and areas requiring clarification. This Clinical Perspective critically appraises PRECISE based on this experience, focusing on the system's key advantages and disadvantages and exploring potential changes to improve the system's utility. These include consideration of image quality when applying PRECISE scoring, incorporation of quantitative thresholds for disease progression, adoption of a PRECISE 3F subcategory for progression not qualifying as substantial, and comparisons with both the baseline and most recent prior examinations. Items requiring clarification include derivation of a patient-level score in patients with multiple lesions, intended application of PRECISE score 5 (i.e., if requiring development of non organ-confined disease), and categorization of new lesions in patients with prior MRI-invisible disease.
AJR. American journal of roentgenology. 2023 Jun 21 [Epub ahead of print]
Nimalan Sanmugalingam, Nikita Sushentsev, Kang-Lung Lee, Iztok Caglic, Cameron Englman, Caroline Moore, Francesco Giganti, Tristan Barrett
Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, United Kingdom., Division of Surgery & Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London, UK, W1W 7TS.