Personalised prostate MRI: tailoring contrast medium use in an era of increasing demand.

Prostate MRI has an established role in early diagnosis, staging, and active surveillance of prostate cancer (PCa), and its demand continues to rise. Moreover, the growing use of active surveillance for patients with low-risk and favourable intermediate-risk prostate cancer, along with ongoing research into MRI-based screening, is expected to further increase the need for MRI follow-up. Routine use of bi-parametric MRI and more selective, evidence-based administration of gadolinium contrast agents may help reduce the growing strain on MRI services. This special report explores scenarios in which contrast enhancement can improve diagnostic confidence, as well as situations where it may be safely omitted. It also examines the potential of on-table monitoring to guide patient-specific contrast administration, highlighting recent evidence suggesting this approach could reduce contrast use in three out of four men without compromising cancer detection or biopsy rates. Finally, the report outlines future research directions aimed at optimising scan times and contrast use in prostate cancer MRI. KEY POINTS: Question With the growing demand for prostate MRI, how can we optimise scanner and specialist time, minimise gadolinium use, and still maintain high diagnostic accuracy? Findings Syer et al demonstrate the feasibility of using on-table monitoring to reduce the number of contrast-enhanced prostate MRI exams by 76%, without compromising cancer detection or biopsy rates. Clinical relevance While promising, the effectiveness of on-table monitoring for guiding contrast-enhanced acquisitions requires further validation. Tailoring imaging protocols to individual patient risk profiles will be essential for optimising resource use while maintaining diagnostic quality.