Background: Most common malignancy among males is prostate cancer causing many deaths.

Aim: To determine the diagnostic accuracy of PI-RADS ≥4 lesions in predicting prostate tumor keeping histopathology as gold standard.

Study Design: Cross-sectional validation.

Methodology: The current project was conducted at Department of Radiology, Armed Forces Institute of Radiology and Imaging, Rawalpindi. Total 114 patients suspicion of prostate carcinoma between 40 to 80 years of age were included. Patients with already diagnosed carcinoma prostate and with inadequate biopsy specimens for diagnosing prostate cancer were excluded. After including the patients in this study, all patients were undergone MRI imaging findings to calculate PI-RADs score as per operational definition. After that biopsy specimens were taken and sent to the histopathology department for determination of Gleason score (GS), a patient was labelled as having significant prostate tumor.

Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of PI-RADS ≥4 lesions in predicting prostate tumor keeping histopathology as gold standard was 84.85%, 83.33%, 87.50%, 80% and 84.21% respectively.

Conclusion: PI-RADS ≥4 is non-invasive modality of choice with high diagnostic accuracy in detecting ca prostate.

Keywords: Prostate Cancer, Prostate Imaging Reporting and Sensitivity