In 2019, the updated version of PI-RADS Version 2.1 was introduced. This version did not change the entire framework, but made several modifications to address limitations and simplify the scoring system. Between 442 patients, both readers had 96 discordant cases in terms of five-point Version 2.1 scoring. Version 2.1 provides high accuracy for detecting clinically significant PCa with category 4 as the threshold. Both readers have good inter-reader reliability. However, agreement for TZ was lower than for PZ lesions.