MRIs Help to Reduce Prostate Biopsies

A study of 23,802 Swedish men found that getting an MRI before scheduling a prostate biopsy was associated with:
• reduced proportion of men who received biopsies,
• reduced biopsies in low-risk prostate cancers (Gleason score of 6 or lower) who usually are not treated, and
• increased detection of the number of men at high risk for prostate cancer (Gleason score greater than 6) who need immediate treatment (JAMA Netw Open, 2023;6(8):e2330233).

Doctors screen for prostate cancer with a blood test called PSA. Men with elevated blood levels of a test called Prostate Specific Antigen (PSA) are usually biopsied to see if they have prostate cancer (Eur Urol, 2020;77(1):78-94). A prostate biopsy involves inserting a tube to cut out a piece of the prostate and look at it under a microscope to determine if it contains a cancer. However, prostate biopsies are very uncomfortable, often painful and have lots of potential complications, so international guidelines now recommend that MRIs be done before a decision is made whether to perform a prostate biopsy (Scand J Urol, 2022;56(4):265-273). An MRI is a non-X ray medical technique that uses a magnetic field and computer-generated radio waves to create detailed pictures of parts of the body. Men with normal prostate MRIs may not need to receive a prostate biopsy.

Why This is the Best Study on the Subject
This study was extremely well done because the authors excluded all men who had a PSA blood test four years before the study period and all men who had previously been diagnosed with prostate cancer. This made it the first dependable study because the four-year run-in period made men included early or late comparable because they had the same PSA measurement history. Previous studies had included subjects who had high PSAs. In this study, all the men with cancer had the same screening PSA blood test measured for the first time after four years as those who did not have prostate cancer, so the cancer and non-cancer groups were comparable in PSA measurements and timing.

My Recommendations
If your PSA is greater than 6, ask your doctor if you should get an MRI. MRIs may save many men from getting a prostate biopsy. Virtually all men will develop prostate cancer if they live long enough, and most men who have prostate cancer will not die of that condition. In one study, almost 50 percent of men ages 70 to 80 who died of non-prostate causes had cancer cells in their prostates (J Urol, Mar 1, 2008;179(3):892-5). Fewer than three percent of the men, diagnosed at average age of 62, had died of prostate cancer 16 years after diagnosis (N Engl J Med, April 27, 2023; 388:1547-1558).
See Active Watching of Prostate Cancer is Usually Safe, but Not Always