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Imaging · London

Prostate mpMRI - London.

Private multi-parametric prostate MRI for PSA workup and active surveillance. 3T scan combining T2, diffusion-weighted and dynamic contrast sequences, reported by a specialist uroradiologist and scored on the PI-RADS scale. Cost £550 to £950 all-inclusive.

What mpMRI is

Multi-parametric MRI of the prostate.

Prostate mpMRI combines three sequences in one sitting: T2-weighted imaging for anatomy and zonal detail, diffusion-weighted imaging (DWI) which highlights densely packed tumour cells, and dynamic contrast enhancement (DCE) which tracks blood flow in and out of any suspicious area after a gadolinium injection.

The reporting radiologist synthesises the three views into a single Prostate Imaging Reporting and Data System (PI-RADS) score for each lesion. PI-RADS 4 and 5 findings direct targeted biopsy; PI-RADS 1 and 2 findings support surveillance without a needle.

Under NICE guideline NG131, mpMRI is the recommended first-line test for suspected prostate cancer. It replaces the older systematic 12-core biopsy pathway, avoids unnecessary biopsy in around one in four men, and improves detection of clinically significant disease.

Indications

When mpMRI is the right test.

  • Rising PSA on serial testing

  • Abnormal digital rectal examination (DRE)

  • Active surveillance follow-up for low-risk disease

  • Family history workup with borderline PSA

  • Biochemical recurrence after surgery or radiotherapy

  • Focal therapy planning (HIFU, cryotherapy)

  • Staging of confirmed prostate cancer

PI-RADS scoring

How your report is scored.

The Prostate Imaging Reporting and Data System assigns each suspicious lesion a score from 1 to 5, indicating the likelihood of clinically significant cancer.

  • PI-RADS 1

    Very low

    Clinically significant cancer highly unlikely.

  • PI-RADS 2

    Low

    Clinically significant cancer unlikely.

  • PI-RADS 3

    Equivocal

    Equivocal - biopsy considered with PSA density.

  • PI-RADS 4

    High

    Clinically significant cancer likely - targeted biopsy indicated.

  • PI-RADS 5

    Very high

    Clinically significant cancer highly likely - targeted biopsy indicated.

Preparation

Before your scan.

  • Avoid ejaculation for 48 to 72 hours before the appointment.
  • A bowel-prep enema an hour before is offered by some centres, optional at others.
  • Allow around 45 minutes in the scanner, plus check-in.
  • A small cannula is placed for gadolinium contrast.
  • Anticoagulation and antiplatelet medication do not need to be held.

Scan protocol

Inside the scanner.

  • 3T MRI is preferred over 1.5T for higher spatial resolution and improved DWI quality.
  • Endorectal coils are rarely used with modern phased-array surface coils.
  • Sequences: T2-weighted axial, sagittal and coronal, DWI with ADC map, DCE post-gadolinium.
  • Total in-scanner time approximately 40 to 45 minutes.

Reporting

Who reads your images.

A specialist uroradiologist is essential; general body radiologists under-detect and over-call. Some London centres offer independent double-reading. The written report specifies PI-RADS 3 to 5 lesions with sector maps, extracapsular extension (EPE), seminal vesicle invasion, pelvic lymph nodes and any bone involvement.

When to biopsy

From report to needle.

  • PI-RADS 4 or 5 at any PSA - targeted MRI/US fusion biopsy indicated.
  • PI-RADS 3 with high PSA density (above 0.15 ng/ml/cc) - biopsy considered.
  • PI-RADS 1 or 2 with normal PSA density - surveillance only, repeat PSA.

Cost and centres

£550 to £950 across London.

All-inclusive pricing usually covers scanner time, gadolinium contrast, cannulation and the consultant uroradiologist report. NHS mpMRI is widely available and NICE-approved as first-line, with typical waits of two to six weeks depending on trust.

  • University College London Hospital Private
  • HCA London Bridge
  • HCA The Wellington
  • Cromwell BUPA
  • One Welbeck
  • London Medical
  • InHealth Group

Frequently asked

Common questions about prostate mpMRI.

  • Do I need a referral for a prostate mpMRI?

    No. Most London private centres accept self-pay bookings without a GP referral. Insurance policies usually require a referral from a private GP or consultant urologist.

  • Is prostate mpMRI covered by private health insurance?

    Yes. Bupa, AXA Health, Vitality, Aviva, WPA and Cigna typically cover mpMRI when a specialist has requested it for suspected prostate cancer or active surveillance. Pre-authorisation is required.

  • Can an mpMRI miss cancer or produce false positives?

    Yes to both. mpMRI misses roughly 10 to 15 per cent of clinically significant cancers, so a PI-RADS 1 or 2 result with rising PSA still warrants urological review. PI-RADS 3 findings are equivocal, and PI-RADS 4 or 5 lesions occasionally turn out to be inflammation rather than cancer on biopsy. Reader experience matters.

  • Why do I need to avoid ejaculation before the scan?

    Recent ejaculation causes seminal vesicle collapse and can distort the diffusion-weighted images. Most centres ask you to abstain for 48 to 72 hours so the images stay clean and PI-RADS scoring stays reliable.

  • Is gadolinium contrast safe?

    Modern macrocyclic gadolinium agents are considered very safe in patients with normal kidney function. Patients with severe renal impairment may have a biparametric MRI (T2 plus DWI, no contrast) instead - the difference in accuracy for most indications is small.

  • Does 3T give a better scan than 1.5T?

    For prostate imaging, yes. 3T scanners produce higher signal-to-noise and better spatial resolution, which helps with small lesion detection. A well-performed 1.5T scan is still diagnostic and remains the standard in some units.

Related

Adjacent tests and treatments.