Patient Perceptions of Standardized Risk Language Used in American College of Radiology Prostate MRI PIRADS Scores

Prostate MRI reports utilize standardized language to describe risk of clinically significant prostate cancer(csPCa) from "equivocal"(PI-RADS 3), "likely"(PI-RADS 4), to "highly-likely"(PI-RADS 5). These terms correspond to risks of 11%, 37%, and 70% according to AUA guidelines, respectively. We assessed how men perceive risk associated with standardized PI-RADS language. We conducted a crowdsourced survey of 1,204 men matching a US prostate cancer demographic. We queried participants' risk perception associated with standardized PI-RADS language across increasing contexts: words-only, PI-RADS-sentence, full-report, and full-report-with-numeric-estimate. Median perceived risk (IQR) and absolute under/overestimation compared with AUA standards were reported. Multivariable linear mixed effects analysis identified factors associated with accuracy of risk perception. Median perceived risks of csPCa (IQR) for the word-only context were "equivocal" 50%(50-74), "likely" 75%(68-85), and "highly-likely" 87%(78-92), corresponding to +39%, +38%, +17% overestimation, respectively. Median perceived risks for the PI-RADS-sentence context were 50%(50-50), 75%(68-81), and 90%(80-94) for PI-RADS 3,4,and 5, corresponding to +39%, +38%, +20% overestimation, respectively. Median perceived risks for the full-report context were 50%(35-70), 72%(50-80), and 84%(54-91) for PI-RADS 3,4,and 5, corresponding to +39%, +35%, +14% overestimation, respectively. For the full-report-with-numeric-estimate context describing a PI-RADS 4 lesion, median perceived risk was 70%(50-80), corresponding to +33% overestimation. Including numeric estimates increased correct perception of risk from 3% to 11% (p