Is PI-RADS equally predictive across racial groups? A narrative review of mpMRI performance in Black versus White men

Multiparametric MRI (mpMRI) has become integral to prostate cancer (PCa) screening, improving detection and reducing unnecessary biopsies. This study investigated radiological disparities in mpMRI between Black and White PCa patients to improve diagnostic equity. A PubMed literature search was conducted using keywords related to prostate cancer, MRI, and racial disparities. Articles discussing mpMRI outcomes in White and Black PCa patients were selected. From 13 studies, two reported higher PI-RADS 4 and 5 scores among Black patients, while three showed higher proportions in White patients without increased clinically significant prostate cancer (csPCa). Clinically significant prostate cancer (csPCa) defined as ISUP Grade Group ≥ 2. The csPCa detection rate in Black patients was equal to or higher than in White patients, with some studies showing more PI-RADS 3 lesions among Black patients with csPCa. Key findings include: 1. Development bias: PI-RADS may not account for racial variations. 2. Inconsistent lesion detection across racial groups. 3. Lower PI-RADS scores may mask clinically relevant cancer in Black patients. 4. Inadequate representation of the disease in Black men. Anatomical variations may affect lesion visibility, requiring dedicated imaging-pathology studies. While valuable for PCa detection, current mpMRI applications may contribute to racial disparities and biopsies should not be omitted in black patients with negative mpMRI or PIRADS 3 lesions. Addressing these disparities requires inclusive research and consideration of racial variations in diagnostic pathways.