A special report from the European Society of Urogenital Radiology Prostate MRI Working Group, published in European Radiology on 15 October 2026, reviews the evidence on using MRI in prostate cancer screening.
The group concludes that MRI-based strategies detect more clinically significant cancer and lead to fewer unnecessary biopsies and fewer diagnoses of insignificant disease than PSA-based pathways alone. Biparametric MRI, without contrast, is favoured for screening because it is quicker and cheaper. Of the two approaches, MRI-first and MRI after an initial PSA, the latter is judged more feasible and probably more cost-effective. Long-term outcomes, including mortality and interval cancers, are not yet known.
This is an expert review rather than a guideline. For Indian centres, where MRI capacity is limited and organised prostate screening does not exist, the more immediate application is the diagnostic pathway: using MRI before biopsy in men with a raised PSA, with consistent PI-RADS reporting and quality assurance.
- Use biparametric MRI where MRI is part of a screening or early-detection pathway
- Position MRI after an abnormal PSA rather than as a first test where capacity is limited
- Report with PI-RADS and audit biopsy yield to maintain quality
- Explain to referrers that long-term mortality benefit is not yet established
Why it matters
It sets the radiologist's role in screening around capacity and quality, not just image interpretation.
Don't overread it
This is an expert review, not a guideline, and mortality benefit from MRI-based screening is unproven.
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