JAMA Oncol

Prostate cancer: Does a negative MRI negate the need for biopsy?

January 4, 2025

Clinical impact: Pre-biopsy MRI has a high negative predictive value (96%) for clinically significant prostate cancer at 3 years, so men with a negative MRI may not have elevated cancer risk and can safely avoid biopsy—provided there’s a safety net of 3-year active programmatic monitoring.

Study details: This multi-site longitudinal cohort study took place at community-based urology practices and academic-based imaging centers in Germany and involved 593 biopsy-naive men (age, 18-75 years) with clinically suspected prostate cancer enrolled 2016-2017. Imaging was 3-T multiparametric MRI. Recommended follow-up included urologist visits every 6 months along with serum PSA, digital rectal exam, and/or transrectal ultrasound as deemed appropriate by the urologist. The urologist was free to perform prostate biopsy or a repeat MRI if indicated.

Results: 48% of men studied had a negative MRI, and 86% of these men avoided biopsy for 3 years. Programmatic monitoring was done over 3 years; in the men with negative MRI who had ongoing elevated clinical risks, clinically significant prostate cancer was detected in 4%.

Source:

Hamm CA, et al. (2024, December 12). JAMA Oncol. Oncological Safety of MRI-Informed Biopsy Decision-Making in Men With Suspected Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/39666360/