Learning Objectives
1. To give an update on the performance characteristics of PI-RADS v2.1
2. To learn the limitations of the v2.1 system and the barriers to issuing updates and reversions
3. To inform on developments that impact the performance of the MRI-diagnosis pathway including image quality, expanded patient selections, optimization of benefits-harm, and deep learning impacts

Key messages:
1. PI-RADS v2.1 is performing as expected; higher prevalence of csPCa with increasing clinical suspicion and a step-function
2. Limitations: persistent highly variable false positive rate & apparently higher prevalence of PI-RADS 3
3. Missing clinical utilities related to the benefits and harm of different MRI biopsy pathways
4. Diagnostic criteria changes are constrained by ACR because clinical pathway impacts need assessing
5. Emerging multistep, quality assured risk stratified MRI pathway incorporating patient preferences
6. Focus: Focus: QA/QC of pathway effectiveness, impacts on biopsy strategies, integration into nomograms, AI in workflow, new indications (screening & AS)