first published 2024. updated March 2026
Medically reviewed by Dr Francesco Giganti Consultant Uroradiologist MBBS, PhD GMC: 7471579
At a Glance
Multiparametric MRI (mpMRI) is now the standard first-line imaging tool for prostate cancer diagnosis in the UK, recommended by NICE guideline NG131. A high-quality prostate MRI helps your clinical team detect clinically significant cancers, avoid unnecessary biopsies, and plan targeted treatments such as focal therapy — preserving quality of life.
Key takeaways:
- Better cancer detection — mpMRI identifies clinically significant cancers while reducing overdiagnosis of low-risk disease
- Guides treatment planning — accurate imaging is essential for determining eligibility for focal therapies such as HIFU (NICE IPG424) and NanoKnife IRE (NICE IPG768)
- Preserves quality of life — MRI-guided focal therapy at The Focal Therapy Clinic achieves 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265)
- Expert interpretation matters — scans should be read by specialist uroradiologists for the most accurate results
- NICE-recommended pathway — NICE NG131 recommends mpMRI before biopsy for all men with suspected prostate cancer
Why Is Prostate MRI Now the Standard of Care?
Multiparametric MRI (mpMRI) has transformed prostate cancer diagnosis and is now recommended by NICE (guideline NG131) as the first-line imaging tool before biopsy. A high-quality prostate MRI allows clinicians to detect clinically significant cancers, avoid unnecessary biopsies, and plan targeted treatments — including focal therapy — with far greater precision than the traditional PSA-only pathway.
Dr Francesco Giganti, Associate Professor and honorary Consultant in Radiology at University College London (GMC: 7471579), is a leading authority on prostate imaging with over 200 peer-reviewed publications. In a recent OnFocus podcast, he discussed how mpMRI has become essential to the prostate cancer diagnostic pathway.
About Dr Francesco Giganti
Role: Associate Professor and honorary Consultant in Radiology, University College London
Expertise: Prostate MRI, active surveillance imaging, MRI-targeted biopsies
Publications: Over 200 peer-reviewed papers on prostate imaging
Research profile: ResearchGate
How Has MRI Transformed Prostate Cancer Diagnosis?
Multiparametric MRI (mpMRI) has replaced the traditional PSA-then-biopsy approach as the recommended first step in prostate cancer diagnosis. NICE guideline NG131 now recommends that all men with suspected prostate cancer receive an mpMRI before any biopsy, allowing clinicians to identify clinically significant cancers while reducing unnecessary biopsies and the overdiagnosis of low-risk disease.
Before mpMRI became standard, diagnosis relied heavily on PSA blood tests followed by systematic biopsies — an approach that sometimes missed significant cancers or detected clinically insignificant ones, leading to overtreatment. As Dr Francesco Giganti explains, mpMRI provides detailed images of the prostate that allow clinicians to assess the size, location, and characteristics of suspicious lesions before any tissue sampling takes place.
| Aspect | Traditional PSA-Biopsy Pathway | mpMRI-First Pathway (NICE NG131) |
|---|---|---|
| First step | PSA blood test → systematic biopsy | PSA blood test → mpMRI before biopsy |
| Biopsy targeting | Systematic (random sampling) | MRI-targeted (guided to suspicious areas) |
| Overdiagnosis risk | Higher (detects low-risk cancers) | Lower (focuses on clinically significant disease) |
| Missed cancers | More likely (anterior tumours often missed) | Less likely (MRI visualises entire gland) |
| NICE recommendation | No longer recommended as first line | Recommended standard (NG131) |
Source: NICE guideline NG131 — Prostate cancer: diagnosis and management
How Does MRI Guide Prostate Cancer Treatment Decisions?
Accurate mpMRI imaging is essential for determining which men are suitable for focal therapy — a targeted approach that treats only the cancerous area of the prostate while preserving surrounding healthy tissue. At The Focal Therapy Clinic, every patient undergoes detailed MRI review as part of a multidisciplinary assessment before any treatment recommendation is made.
Dr Francesco Giganti emphasises that the quality of the MRI directly influences treatment planning. A high-resolution scan allows the clinical team to map the precise location, size, and extent of the tumour — information critical for planning targeted treatments such as HIFU (High-Intensity Focused Ultrasound), approved by NICE under IPG424, or NanoKnife IRE, approved under NICE IPG768.
In our clinic’s experience with over 2,000 focal therapy procedures, MRI-guided treatment planning contributes to outcomes including 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265).
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What Are the Benefits of MRI-Guided Focal Therapy?
MRI-guided focal therapy treats only the cancerous area of the prostate, resulting in fewer side effects and faster recovery than whole-gland treatments such as radical prostatectomy or radiotherapy. At The Focal Therapy Clinic, our patient data demonstrates the benefits of precise MRI-guided treatment planning.
| Outcome | Focal Therapy (FTC data) | Radical Prostatectomy |
|---|---|---|
| Sexual function preserved | 90%+ | 30–70% |
| Urinary continence | 97% (FTC audit, n=265) | 80–95% |
| Recovery time | 1–2 weeks | 4–6 weeks |
| Hospital stay | Day-case (home same day) | 1–3 nights |
| NICE status | HIFU: IPG424 | NanoKnife: IPG768 | Standard care |
Source: FTC one-year outcome audit (n=265) and published literature
As Dr Francesco Giganti notes, high-quality MRI is the foundation of these outcomes — precise imaging allows the clinical team to target treatment accurately, preserving healthy tissue and maintaining quality of life.
“The quality of the MRI directly determines the quality of the treatment plan. A high-resolution multiparametric scan allows us to map the tumour precisely, which is essential for focal therapy to achieve its potential.”
What Should You Ask About MRI Quality at Your Hospital?
Not all prostate MRI scans are equal. Dr Francesco Giganti advises patients to ask specific questions about the MRI equipment and reporting at their treatment centre, as scan quality directly affects diagnostic accuracy and treatment planning.
Questions to Ask Your Hospital About Prostate MRI
- Is it multiparametric? — A standard MRI is not sufficient. You need multiparametric MRI (mpMRI) that includes T2-weighted, diffusion-weighted, and contrast-enhanced sequences
- What magnet strength? — 3-Tesla MRI scanners provide higher resolution than 1.5-Tesla for prostate imaging
- Who reports the scan? — Scans should be interpreted by a specialist uroradiologist experienced in prostate MRI, not a general radiologist
- Is PI-RADS scoring used? — The Prostate Imaging Reporting and Data System (PI-RADS) standardises how MRI findings are reported, scoring lesions from 1 (very low risk) to 5 (very high risk)
- Can I get a second opinion? — If you are unsure about your results, you have the right to seek a second opinion from a specialist centre
At The Focal Therapy Clinic, all MRI scans are reviewed by specialist uroradiologists including Dr Clare Allen (FRCR, GMC: 3108389), ensuring accurate PI-RADS scoring and detailed tumour mapping before any treatment decision is made.
What Should You Do Next?
If you have been diagnosed with prostate cancer or are awaiting further investigation, ensuring access to a high-quality multiparametric MRI is one of the most important steps you can take. At The Focal Therapy Clinic, your MRI is reviewed by specialist uroradiologists as part of a comprehensive assessment to determine whether focal therapy may be suitable for you.
- Request your MRI images — you are entitled to a copy of your scan for a second opinion
- Ask about mpMRI — ensure your scan is multiparametric, not a standard MRI
- Book a consultation — our team can review your existing MRI and advise on next steps, including whether focal therapy is an option
To discuss your diagnosis or request an MRI review, contact The Focal Therapy Clinic or call our patient coordinator team.
Listen to the Full Podcast
Hear Dr Francesco Giganti discuss the role of MRI in prostate cancer diagnosis and treatment on the OnFocus podcast:
