Multiparametric magnetic resonance imaging is becoming more commonly employed in identifying and assessing the risk of prostate cancer. Ongoing efforts are needed to establish standardized techniques and provide proper training to radiologists for its optimal use. To meet these needs, an international expert panel, consisting of the American College of Radiology, European Society of Urogenital Radiology, and AdMeTech Foundation, collaborated to create the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2).(1)

The PIRADS is the scoring system that categorizes prostate findings based on the level of suspicion of malignancy, according to various key characteristics and their behavior on magnetic resonance imaging of prostate lesions, on a scale from 1 to 5.(2)

The magnetic resonance information should be organized in a systematic manner, incorporating the following key elements: gland dimensions and volume measurement and description of prostate zones and significant lesion description.

Gland Dimensions and volume measurement assess the dimensions of the gland and measure its volume, providing valuable information for operability evaluation. Evaluate the impact of adenoma on the bladder floor, particularly focusing on the median lobe.

Description of Prostate Zones: Peripheral Zone, Comment on the overall appearance, indicating whether the gland is easily interpretable (clear T2 hyperintensity) or if degenerative changes (e.g., bleeding) are present, hindering interpretation. Transition Zone: Provide details on overall volume, symmetry, and the associated repercussions. Anterior Fibromuscular Stroma: Describe its development, noting whether it appears nodular and whether it enhances with contrast.

Significant Lesion Description: For each lesion, include the following: Axial size in millimeters, topography based on the standardized 36-sector diagram (table1), specifying the main sector and adjacent sectors affected. Assign a suspicion score ranging from 1 to 5 to characterize the level of concern or potential malignancy.(3)

The increased sensitivity provided by the Prostate Imaging Reporting and Data System in approaching the diagnosis of malignant lesions makes it essential and easily accessible for Radiology residents nowadays.