Medical XpressUse of MRI Before Prostate Biopsies Increases Sharply Across US Hospitals

ℹ️ Observational Association Only Evidence

Researchers analyzed more than 505,000 prostate biopsies performed between 2017 and mid-2026 using data from Epic Cosmos. The study evaluated adoption of prebiopsy MRI following randomized trials and guideline updates supporting MRI-guided prostate cancer evaluation. MRI utilization increased from 14% to 64% among men undergoing an initial biopsy and from 38% to 67% among men with a prior negative biopsy. Despite substantial growth, investigators identified ongoing gaps in utilization and variability across patient populations.

Clinical Considerations

• Prebiopsy MRI use increased from 14% in 2017 to 64% in 2026 among men undergoing an initial biopsy.
• Among men with a previous negative biopsy, MRI utilization rose from 38% to 67% over the study period.
• The analysis included more than 505,000 prostate biopsies, providing a large national assessment of practice adoption.
• Investigators reported that approximately one-third of men undergoing an initial biopsy still did not receive MRI before biopsy.
• MRI utilization declined among men with very high PSA levels and among patients older than 80 years.
• The study evaluated utilization trends rather than diagnostic performance, cancer outcomes, or mortality effects.

Practice Applications

• Consider whether prebiopsy MRI has been incorporated consistently into diagnostic pathways for biopsy-eligible patients.
• Review local utilization patterns to identify potential gaps between clinical practice and contemporary guideline recommendations.
• Evaluate patient access barriers, including imaging availability, quality standards, and insurance coverage.
• Interpret utilization increases as evidence of practice adoption rather than direct evidence of improved outcomes within this analysis.
• Monitor ongoing research assessing MRI quality, access disparities, and effects on diagnostic performance.