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Patient Perceptions of Standardized Risk Language Used in ACR Prostate MRI PI-RADS Scores

Introduction: Prostate MRI reports use standardized language to describe risk of clinically significant prostate cancer (csPCa) from "equivocal" (Prostate Imaging Reporting and Data System [PI-RADS] 3), "likely" (PI-RADS 4), to "highly likely" (PI-RADS 5). These terms correspond to risks of 11%, 37%, and 70% according to American Urological Association guidelines, respectively. We assessed how men perceive risk associated with standardized PI-RADS language.

Methodology: We conducted a crowdsourced survey of 1,204 men matching a US prostate cancer demographic. We queried participants' risk perception associated with standardized PI-RADS language across increasing contexts: words only, PI-RADS sentence, full report, and full report with numeric estimate. Median perceived risk (interquartile range) and absolute under/overestimation compared with American Urological Association standards were reported. Multivariable linear mixed-effects analysis identified factors associated with accuracy of risk perception.

Results: Median perceived risks of csPCa (interquartile range) for the word-only context were "equivocal" 50% (50%-74%), "likely" 75% (68%-85%), and "highly likely" 87% (78%-92%), corresponding to +39%, +38%, and +17% overestimation, respectively. Median perceived risks for the PI-RADS-sentence context were 50% (50%-50%), 75% (68%-81%), and 90% (80%-94%) for PI-RADS 3, 4, and 5, corresponding to +39%, +38%, and +20% overestimation, respectively. Median perceived risks for the full-report context were 50% (35%-70%), 72% (50%-80%), and 84% (54%-91%) for PI-RADS 3, 4, and 5, corresponding to +39%, +35%, and +14% overestimation, respectively. For the full-report-with-numeric-estimate context describing a PI-RADS 4 lesion, median perceived risk was 70% (50%-%80), corresponding to +33% overestimation. Including numeric estimates increased correct perception of risk from 3% to 11% (P < .001), driven by men with higher numeracy (odds ratio 1.24, P = .04).

Conclusion: Men overestimate risk of csPCa associated with standardized PI-RADS language regardless of context, especially for PI-RADS 3 and 4 lesions. Changes to PI-RADS language or data-sharing policies for imaging reports should be considered.

Jeremiah R Dallmer,1 Michael Luu,2 Rola Saouaf,3 Brennan Spiegel,4 Stephen J Freedland,5 Timothy J Daskivich6

  1. Resident, Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
  2. Staff Biostatistician, Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California.
  3. Professor of Radiology, Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California.
  4. Professor of Medicine and Public Health, George and Dorothy Gourrich Chair in Digital Health Ethics, Director of Health Services Research, Cedars-Sinai Center for Outcomes Research and Education, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
  5. Professor of Urology, Warschaw Robertson, and Law Families Chair in Prostate Cancer, Director, Center for Integrated Research in Cancer and Lifestyle, Associate Director of Education and Training for Cedars-Sinai Cancer, Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
  6. Associate Professor of Urology, Director of Academic Urologic Oncology, Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: .

Source: Dallmer J., Luu M., Saouaf R. et al. Patient Perceptions of Standardized Risk Language Used in ACR Prostate MRI PI-RADS Scores. J Am Coll Radiol. 2024 Jun 14:S1546-1440(24)00518-0. doi: 10.1016/j.jacr.2024.04.030.