The screening for prostate cancer is burdened by a high rate of overdiagnosis and also a relatively high degree of complications from biopsy and treatments that don’t extend life or quality of life.

When it comes to diagnostic accuracy, MRI was found to be better than traditional prostate biopsy. A study published in the Canadian Medical Association Journal found that MRIs are accurate in diagnosing prostate cancer 93% of the time, compared with only 48% for traditional, non-targeted biopsies. While there are a range of factors that might impact those results, they suggest that a high quality MRI is not just good but preferred for detecting prostate cancer.

A recent study in NEJM looked at over 37,000 men who were between 50 and 60 years of age who underwent prostate-specific antigen (PSA) screening. Those patients with a PSA level of greater than 3 ng per milliliter underwent magnetic resonance imaging (MRI) of the prostate; one third of the participants were randomly assigned to a reference group that underwent systematic biopsy as well as targeted biopsy of suspicious lesions shown on MRI. The remaining 2/3 of participants were assigned to the experimental group and underwent MRI-targeted biopsy only. The primary outcome was clinically insignificant prostate cancer, defined as a Gleason score of 3+3. The secondary outcome was clinically significant prostate cancer, defined as a Gleason score of at least 3+4. Safety was also assessed.The BOTTOM LINE is if you have a biopsy if the avoidance of systematic biopsy in favor of MRI-directed targeted biopsy for screening and early detection in persons with elevated PSA levels reduced the risk of overdiagnosis by half at the cost of delaying detection of intermediate-risk tumors in a small proportion of patients.