SUMMARY:
Artificial intelligence may assist with interpreting prostate MRI by improving accuracy and reducing variability between readers with different experience levels. A tested AI system trained on thousands of prostate MRIs performed as well as, or better than, human radiologists using the PI-RADS v2.1 system to detect significant prostate cancer. Such tools may help address the growing demand for expert MRI interpretation while supporting more consistent diagnostic decisions.
Why is Artificial Intelligence (AI) being developed to interpret prostate MRI?
Developers of Artificial Intelligence (AI) for use in reading prostate MRI scans believe AI may perform as well as or better than human readers for detecting clinically significant prostate cancer.
Research and development are aimed at improving the accuracy of clinical diagnosis for patients. At the same time, by increasing efficiency it will make professional life less burdensome for busy radiologists.
Is there a shortage of expert readers for prostate MRI, and can AI help?
There is a shortage of expert readers but AI may help fill the gap. According to a May, 2024 published study, the new standard of prostate MRI before biopsy has generated a growing need for radiologic readers who can interpret the MRI reports and make decisions about biopsies.[i] The authors note, “Interpreting prostate MRI images requires a specialized skill set.”
It takes years of training and experience to gain excellence in reading prostate MRI. As expert Dr. Dan Sperling has written, “The most important factor in best results is skill. No one is born skilled.”
Doesn’t PI-RADS standardize how to read MRI images?
PI-RADS (Prostate Imaging Reporting and Data System) is a scoring system designed to standardize the protocol for scanning and interpreting multiparametric MRI. It provides guidelines for radiologic readers to identify probable significant prostate cancer by assigning a PI-RADS score >2 (equal to or greater than 2, using a 5-point scale).
The current version, PI-RADSv2.1, is the most detailed and specific version since PI-RADS was introduced in 2012. It is today’s MRI reporting standard for suspected clinically significant prostate cancer before biopsy.
However, even PI-RADS is subject to human understanding and experience. Thus, even though the latest PI-RADS version is highly descriptive, more experienced radiologists assign more accurate scores than those with less experience.[ii] It has been suggested that PI-RADSv2.1 needs improvement.[iii] AI may be able to increase reader accurately if it is properly trained and tested.
Can AI improvements increase interpretation accuracy regardless of reader experience?
The question of whether AI can increase reader accuracy regardless of radiologist experience is a good one, and worth putting to the test. In fact, a multi-national team of radiology experts designed a comparison between a special AI program they developed and trained vs. human readers to determine if AI was non-inferior (at least as good) or better than human readers.
Both the AI program and the radiologic readers utilized the PI-RADSv2.1 scoring system to identify clinically significant prostate cancer on patient MRI scans.
The AI program was trained on over 9000 MRI examinations, and tested on 1000 other cases. From the testing cohort, the investigators assigned 400 paired cases to both the AI program, and to 62 radiologists (from 20 countries, average 7 years of experience reading prostate MRI).
Did the AI program perform as well as the human readers?
On average, the AI program outperformed the radiologic readers. The investigators found that it was “superior to radiologists using PI-RADS (2.1), on average, at detecting clinically significant prostate cancer and comparable to the standard of care.”[iv]
While validation and more testing are needed, this study has significant implications for the ability of AI to improve interpretation of prostate MRI. It has the potential to benefit both patients and radiologists.
FAQ: Artificial Intelligence & Prostate MRI Interpretation
Q: Is PI-RADS the same as Gleason score?
A: PI-RADS is a one-to-five scoring system for MRI scans of the prostate. The higher the score, the greater the likelihood that clinically significant prostate cancer is present. It influences the decision to do a biopsy. On the other hand, the Gleason score is based on the biopsy tissue samples, and is also a one-to-five scoring system. It is the only way to diagnose prostate cancer. The higher the score, the more aggressive the disease. It influences treatment decisions.
Q: If a doctor is using an Artificial Intelligence program to help with diagnosis, does that mean a machine is making my diagnosis and treatment decisions?
A: Absolutely not! Artificial Intelligence can rapidly identify things the human eye might miss, giving additional information to a doctor. It is about information, not decision-making. The doctor always has the decision-making power, and more information equipes the doctor for better decision-making.
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated January 2026.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Miszewski K, Skrobisz K, Miszewska L, Matuszewski M. Interpreting Prostate MRI Reports in the Era of Increasing Prostate MRI Utilization: A Urologist's Perspective. Diagnostics (Basel). 2024 May 20;14(10):1060.
[ii] Mussi TC, Yamauchi FI, Tridente CF, Tachibana A et al. Interobserver agreement of PI-RADS v. 2 lexicon among radiologists with different levels of experience. J Magn Reson Imaging. 2020 Feb;51(2):593-602.
[iii] Cooperberg MR, Bihn JR, Culnan JM, La J et al. Magnetic Resonance Imaging or Confirmatory Biopsy for Patients With Prostate Cancer Receiving Active Surveillance. JAMA Oncol. 2026 Jan 1;12(1):111-113.
[iv] Ibid.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
