Multiparametric MRI Might Optimize Evaluation of Men with Elevated Prostate-Specific Antigen Levels

Multiparametric magnetic resonance imaging (MRI) of the prostate provides anatomic, functional, and vascular information; it can be used to guide biopsy decisions in men undergoing prostate-specific antigen (PSA) screening (NEJM JW Gen Med Feb 15 2017 and Lancet 2017; 389:815). In this multicenter trial, 500 men with suspected localized prostate cancer (based on PSA level or digital rectal examination) were randomized either to standard biopsies (10–12 cores) guided by transrectal ultrasound, or to multiparametric MRI-targeted evaluation. In the latter group, only those patients whose MRI results were equivocal or suggestive of cancer underwent biopsy (targeted to abnormal areas on MRI).

Key findings were as follows:

• In the MRI group, 28% of …