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Background: Magnetic resonance imaging (MRI) of the prostate is a new, more accurate, non-invasive test for prostate cancer diagnosis. Aim: To understand the acceptability of MRI for patients and GPs for prostate cancer diagnosis. Design and setting: Qualitative study of men who had undergone a prostate MRI for possible prostate cancer, and GPs who had referred at least one man for possible prostate cancer in the previous 12 months in West London and Devon. Method: Semi-structured interviews, conducted in person or via telephone, were audio-recorded and transcribed verbatim. Deductive thematic analysis was undertaken using Sekhon's Theoretical Framework of Acceptability, retrospectively for patients and prospectively for GPs. Results: Twenty-two men (12 from Devon, age range 47–80 years), two patients' partners, and 10 GPs (6 female, age range 36–55 years) were interviewed. Prostate MRI was broadly acceptable for most patient participants, and they reported that it was not a significant undertaking to complete the scan. GPs were more varied in their views on prostate MRI, with a broad spectrum of knowledge and understanding of prostate MRI. Some GPs expressed concerns about additional clinical responsibility and local availability of MRI if direct access to prostate MRI in primary care were to be introduced. Conclusion: Prostate MRI appears to be acceptable to patients. Some differences were found between patients in London and Devon, mainly around burden of testing and opportunity costs. Further exploration of GPs' knowledge and understanding of prostate MRI could inform future initiatives to widen access to diagnostic testing in primary care. [ABSTRACT FROM AUTHOR]

Objective: To compare biopsy recommendation rates and accuracy of the Prostate Imaging‐Reporting and Data System, version 2 (PI‐RADSv2) with the Likert scale for detection of clinically significant and insignificant prostate cancer in men screened within the Imperial Prostate 1 Prostate Cancer Screening Trial Using Imaging (IP1‐PROSTAGRAM). Patients and Methods: Men aged 50–69 years were screened with Prostagram MRI. Scans were prospectively reported using both PI‐RADSv2 (excluding dynamic contrast‐enhanced sequence score) and 5‐point Likert scores by expert uro‐radiologists. Systematic and targeted transperineal biopsy was recommended if the scan was scored ≥ 3, based on either reporting system. The proportion of patients recommended for biopsy and detection rates for Grade Groups (GGs) 1 and ≥ 2 were compared. Receiver operating characteristic (ROC) analysis was performed to compare performance. Results: A total of 406 men underwent Prostagram MRI. The median (interquartile range) age and prostate‐specific antigen level were 57 (53–61) years and 0.91 (0.56–1.74) ng/mL, respectively. At MRI score ≥ 3, more patients were recommended for biopsy based on Likert criteria (94/406; 23%, 95% confidence interval [CI] 19.2%–27.6%) compared to PI‐RADSv2 (72/406; 18%, 95% CI 14.2%–21.9%; P = 0.03). For MRI scores ≥ 4, PI‐RADSv2 and Likert scales led to 43/406 (11%, 95% CI 7.9%–14.1%) and 35/406 (9%, 95% CI 6.2%–11.9%) men recommended for biopsy (P = 0.40). For GG ≥ 2 detection, PIRADSv2 and Likert detected 22% (95% CI 11.4%–30.8%, 14/72) and 16% (95% CI 9.5%–25.3%, 15/94), respectively (P = 0.56). For GG1 cancers detection these were 11% (95% CI 4.3%–19.6%, seven of 72) vs 11% (95% CI 4.7%–17.8%, nine of 94; P = 1.00). The accuracy of PI‐RADSv2 and Likert scale was similar (area under the ROC curve 0.64 vs 0.65, P = 0.95). Conclusions: In reporting non‐contrast‐enhanced Prostagram MRI in a screening population, the PI‐RADSv2 and Likert scoring systems were equally accurate; however, Likert scale use led to more men undergoing biopsy without a subsequent increase in significant cancer detection rates. To improve reporting of Prostagram MRI, either the PI‐RADSv2 or a modified Likert scale or a standalone scoring system should be developed. [ABSTRACT FROM AUTHOR]