The European Society of Urogenital Radiology prostate MRI working group reviewed the evidence on using MRI in prostate cancer screening. This is a narrative special report, not a new trial.
Across the large screening trials, adding MRI found more clinically significant cancers while reducing unnecessary biopsies and diagnoses of indolent disease. The group favours biparametric MRI — without contrast — because it is shorter, simpler and cheaper. Two models have emerged: MRI first for everyone, which maximises detection but needs capacity few systems have, and risk-stratified pathways in which MRI follows an abnormal PSA or risk score, which look more feasible and cost-effective. Long-term data on mortality and interval cancers are still missing.
For radiology departments, the practical question is capacity and quality. Screening reads need standardised protocols, reader training and audit, and a reporting threshold agreed with urology. Where MRI capacity is limited, the reflex model is the realistic one.
- Where MRI is used in a screening pathway, consider biparametric protocols to save time and contrast.
- Use MRI as a reflex test after a raised PSA or risk score rather than as a first-line screen where capacity is limited.
- Agree a PI-RADS threshold for biopsy with urology before starting a screening service.
- Build in double reading or audit; screening populations have lower prevalence and more false positives.
- Tell patients that the effect of MRI-based screening on mortality is not yet known.
Why it matters
MRI is moving from diagnosis into screening, and radiology capacity will decide which model is workable.
Don't overread it
A narrative expert report — it does not show that MRI-based screening reduces prostate cancer deaths.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for radiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free