Prostate MRI – Multiparametric Imaging at the Highest Diagnostic Level.

Indications and Clinical Integration

Prostate MRI is firmly established in urological diagnostics and is recommended in the following scenarios:

• Elevated or rising prostate-specific antigen (PSA) levels
• Suspicious digital rectal examination (DRE)
• Persistent clinical suspicion despite negative biopsy
• Pre-treatment staging in confirmed prostate cancer
• Active surveillance and detection of recurrence

mpMRI is increasingly used as a first-line imaging modality prior to initial biopsy.

Multiparametric MRI (mpMRI) and PI-RADS

mpMRI combines anatomical and functional imaging techniques:

• T2-weighted imaging (high-resolution anatomy)
• Diffusion-weighted imaging (DWI) with ADC mapping
• Dynamic contrast-enhanced imaging (DCE)

Interpretation is performed according to PI-RADS (Prostate Imaging Reporting and Data System):

• PI-RADS 1–2: low likelihood of clinically significant cancer
• PI-RADS 3: intermediate likelihood
• PI-RADS 4–5: high likelihood of clinically significant cancer

This standardized classification ensures clear communication with referring urologists and provides a robust basis for further clinical decision-making.

PSA Density and Risk Stratification

Combining mpMRI findings with clinical parameters significantly improves risk assessment.

A key parameter is PSA density (PSAD):​

• PSAD < 0.15 ng/ml/ml: lower likelihood of clinically significant cancer
• PSAD ≥ 0.15 ng/ml/ml: increased risk

PSA density is particularly valuable in PI-RADS 3 lesions, where it helps guide the decision for or against biopsy.

MRI-Guided Biopsy Planning

mpMRI enables precise localization of suspicious lesions and serves as the basis for:

• MRI/ultrasound fusion-guided biopsy
• Cognitive targeting approaches
• Reduction of unnecessary systematic biopsies

This results in improved detection of clinically significant cancers while minimizing overdiagnosis.

Staging and Treatment Planning

In patients with confirmed prostate cancer, MRI provides essential information for treatment planning:

• Tumor localization and volume
• Detection of extracapsular extension (ECE)
• Seminal vesicle invasion (SVI)
• Relationship to neurovascular bundles

These findings are critical for surgical planning (e.g., nerve-sparing prostatectomy) and radiotherapy strategies.

Active Surveillance and Follow-up

mpMRI is a cornerstone of modern active surveillance strategies for low-risk prostate cancer:

• Monitoring of PI-RADS lesions over time
• Detection of progression (e.g., size increase, ADC changes)
• Reduction of repeated invasive biopsies

Quality and Standardization

Our prostate MRI service is characterized by:

• Adherence to international guidelines (PI-RADS v2.1)
• Standardized imaging protocols ensuring reproducibility
• Structured reporting
• Experienced radiologists with high case volumes

Patient Comfort

Prostate MRI is a non-invasive and patient-friendly examination:

• No radiation exposure
• No endorectal coil required
• Examination time approximately 20–30 minutes
• High image quality with excellent patient comfort

Your Benefits

• Highly accurate detection of clinically significant prostate cancer
• Integration of PI-RADS and PSA density into reporting
• Optimized biopsy planning
• Support for treatment decisions and follow-up strategies
• State-of-the-art MRI technology and specialized expertise

For further details on the completely pain-free mpMRI of the prostate, please refer to our patient leaflet.

Note: The costs of the examination are usually reimbursed by private health insurance companies. 

Information for patients with statutory health insurance: As a qualified and certified partner of a special care program of statutory health insurance companies, we offer you the opportunity to take advantage of a multiparametric prostate MRI in our MVZ in case of a justified suspicion or already confirmed diagnosis of prostate carcinoma, without any additional or self-payments. In addition to the DAK, numerous BKKs are participating in the program. You can find participating company health insurance companies in the program here. If your statutory health insurance company does not participate, we can only offer you multiparametric prostate MRI as a self-pay service (IGeL).