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PRECISE 1\u20132 indicates radiological regression, PRECISE 3 stability, and PRECISE 4\u20135 progression. Our aim was to test the PRECISE score as a predictive tool for disease progression in a multicentre international setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This is a retrospective study in which we collected data from 22 international centres from December 2005 to July 2022, applying two entry criteria: (1) at least two scans (baseline and follow-up); (2) at least two biopsies (baseline and follow-up, the latter after the second scan). Local radiologists reported scans according to PRECISE. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to different biopsy thresholds and definitions of progression were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1667 patients were included. Median follow-up was 4 years (IQR: 2.1\u20136.3). A total of 1248 (75%) patients underwent two MRIs and immediate subsequent biopsy, 300 (24%) of which had biopsy progression to Grade Group \u2265 2 and 77 (6%) to Grade Group \u2265 3. Patients with PRECISE 4\u20135 had 4.53-fold increased odds (95% CI: 3.37\u20136.12;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) of biopsy progression compared to PRECISE 1\u20133. Using a PRECISE\u2009\u2265\u20094 cutoff to perform follow-up biopsies, overall\u00a0sensitivity, specificity, PPV and NPV were 57%, 79%, 46%, and 85% for the first follow-up scan.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PRECISE recommendations could lead to timely identification of patients on AS who progress on MRI, prompting re-biopsy or treatment, and safe reduction of repeat biopsies for those with stable MRI and prostate-specific antigen kinetics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can the PRECISE scoring system for monitoring prostate cancer lesions on active surveillance on MRI predict disease progression and avoid unnecessary biopsies?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The PRECISE score effectively predicts prostate cancer progression, with PRECISE 4\u20135 (progression) scores indicating 4.53-fold increased odds of biopsy progression compared to PRECISE 1\u20133 (regression\/stability).<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>This study validates PRECISE as a tool for managing patients on active surveillance. It can help clinicians identify those needing timely re-biopsy or treatment, while reducing unnecessary biopsies in patients with stable disease on imaging and PSA kinetics.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12570-z","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T14:30:13Z","timestamp":1777905013000},"page":"7940-7953","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Multicentre validation of the PRECISE scoring system for prostate MRI during active 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He reports consulting fees from DeepHealth, SpectraCure and Procept outside of the submitted work. He has received speaker fees from Bayer and Siemens. He is a member of the Scientific Editorial Board of\n                      European Radiology\n                      and, as such, did not participate in the selection or review processes for this article. Dr. Claudia Kesch reports consulting and speaker fees from Novartis, Pfizer, and Bayer; travel support from Pfizer, Amgen and Bayer; grants or contracts from Novartis, Amgen and Mariana Oncology. Dr A.K. Tewari has served as a site-PI on pharma\/industry-sponsored clinical trials from Kite Pharma, Lumicell, Inc., Dendreon, and Oncovir, Inc. He has received research funding (grants) to his institution from DOD, NIH, Axogen, Intuitive Surgical, AMBFF, and other philanthropy. He has served as an unpaid consultant to Roivant Biosciences and an advisor to Promaxo. He owns equity in Promaxo. Prof. Caroline M. Moore is an NIHR Research Professor and receives grant funding from the Medical Research Council, Cancer Research UK, Movember, Prostate Cancer UK, and the EAU Foundation, and study funding from SpectraCure. Prof. Boris Hadaschik reports consulting fees from Johnson&Johnson, Bayer, ABX, Astellas, Merck, Amgen, MSD\/Pfizer, Novartis, BMS, Monrol, Onkowissen, POINT Biopharma, Ipsen, AstraZeneca, Lightpoint Medical, Telix, and Accord Healthcare; travel support from AstraZeneca, BMS, Janssen, Bayer, and Ipsen; grants or contracts from Janssen, Deutsche Forschungsgesellschaft, Novartis, and BMS; participation on data safety monitoring boards for Johnson&Johnson and ABX. V.P. is a member of the Scientific Editorial Board of\n                      European Radiology\n                      and, as such, did not participate in the selection or review processes for this article.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was not required for this study because all clinical records and MR images were routinely reviewed as part of an audit performed for the internal evaluation of the AS service, as per the standard of care by the treating team.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was not required for this study because all clinical records and MR images were routinely reviewed as part of an audit performed for the internal evaluation of the AS service, as per the standard of care by the treating team.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Some study subjects or cohorts (UCLH and Cambridge) have been previously reported in: Giganti et al [\n                      \n                      ] and Caglic et al [\n                      \n                      ].","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}