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Increasingly, urologists are using magnetic resonance imaging (MRI) to guide decisions on whether to perform biopsies in men whose prostate-specific antigen (PSA) levels are elevated on prostate cancer screening; MRI also facilitates targeted biopsy of suspicious areas. In this trial from Sweden, about 1500 men (age range, 50–74) with screening PSA levels ≥3 ng/mL were randomized to standard random 12-core prostate biopsy or to initial MRI. In the latter group, patients whose MRIs were suspicious for cancer underwent both standard random biopsies and targeted biopsies of suspicious areas. Outcomes were as follows:
A lower proportion of patients in the MRI group than in the standard group underwent biopsy (36% vs. 73%).
In intent-to-treat anal…