September is Prostate Cancer Awareness Month.
Learn the facts and understand your options.
Learn the facts and understand your options.
If your PSA (prostate-specific antigen, a blood protein that can rise with cancer and with benign conditions) has come back higher than expected, the next steps can feel unclear. You may hear about a prostate MRI, a biopsy, or both. Historically, prostate biopsy was usually performed using systematic sampling, without first using MRI to identify a suspicious target.
A research letter published in JAMA Oncology on September 17, 2026, offers the most current picture of how often men in the U.S. have an MRI before a prostate biopsy. Read alongside earlier research covering 2007 to 2022, it shows how quickly practice has shifted, and where it still varies.
For many years, a prostate biopsy meant systematic sampling: taking around 10 to 12 small tissue cores from set areas of the prostate, guided by ultrasound. This approach can miss some significant cancers and can find small, low-grade cancers that may never cause harm.
A prostate MRI changes the order of things. The scan can show areas that look suspicious, and a targeted biopsy can then sample those specific areas. In the PRECISION trial, an MRI-first approach found more clinically significant prostate cancer, commonly defined in studies as Grade Group 2 or higher, and fewer low-risk cancers than standard biopsy. Under the trial protocol, about 28% of men assigned to the MRI pathway did not undergo biopsy because their MRI did not show a suspicious area.
Guidelines have followed the evidence, with some regional differences. In the U.S., the AUA/SUO guideline says clinicians may use MRI before a first biopsy to improve detection of clinically significant cancer. When MRI shows a suspicious lesion, it recommends targeted biopsy, with systematic sampling as an option. When MRI shows no suspicious lesion but overall risk remains elevated, systematic biopsy may still be appropriate. In Europe, the EAU recommends MRI before biopsy for men with suspected cancer confined to the prostate. In the UK, NICE recommends multiparametric MRI as the first investigation for suspected localized prostate cancer.
Researchers from University Hospitals Cleveland, Case Western Reserve University and Weill Cornell Medicine used Epic Cosmos, a database that pools electronic health records from many U.S. hospitals. They studied 505,206 biopsies in 474,026 men aged 40 to 90 with no prior prostate cancer. A biopsy counted as having pre-biopsy MRI if the man had a pelvic or prostate MRI within the previous 9 months, or MRI guidance on the day of biopsy.
The main finding was a steep rise over time:
MRI use has long been higher after a negative biopsy, when it can help show whether an area was missed.
A Stanford team published an earlier study in Prostate Cancer and Prostatic Diseases using insurance claims from 872,829 biopsies in 726,663 men. Pre-biopsy MRI rose from 0.5% in 2007 to 16.4% in 2017 and 35.5% in 2022.
Because the studies used different populations, databases and definitions, their percentages should be read as two separate snapshots rather than one continuous timeline. Although the studies overlap in 2017, their estimates should not be compared directly. What they independently show is the same overall direction: substantially increasing use of MRI before biopsy.
The earlier study found an urban-rural gap in 2022 (36.1% versus 28.3%). The newer study found no statistically significant difference by rural-urban category from 2024 onward. Because the studies used different datasets and methods, this does not establish that the earlier geographic gap has disappeared.
The trend extends beyond the U.S. The earlier study noted that pre-biopsy MRI in Denmark rose from 22% in 2020 to 52% in 2022, in line with European guidance.
The newer study also looked at how pre-biopsy MRI use varied among patient groups between 2024 and 2026.
Race. Non-Hispanic White men were more likely than non-Hispanic Black men to have pre-biopsy MRI, by 7.6 percentage points for a first biopsy and 6.8 points after a prior negative biopsy. The authors highlighted this because Black men in the U.S. have higher rates of prostate cancer diagnosis and death. The study was not designed to explain the gap, and insurance, MRI availability and referral patterns were not fully captured.
Age. For men aged 40 to 80, MRI use for a first biopsy was roughly 50% to 60%. It was lower for men over 80.
PSA level. Among men having a first biopsy, MRI use fell as PSA rose. The authors suggest that at high PSA levels, some clinicians may have felt a systematic biopsy was likely to find cancer anyway.
MRI can identify suspicious areas, guide targeted biopsy, estimate prostate volume, and add information used in monitoring and treatment discussions. A PI-RADS score (or, in some UK centres, a five-point Likert score) describes how suspicious an area appears on MRI; it is not the same as a diagnosis. Diagnosis usually depends on tissue from a biopsy, examined by a pathologist.
A negative MRI lowers risk, but it does not reduce the risk to zero. MRI interpretation can also vary, because scan quality, lesion location, reader experience and clinical context all matter.
If a biopsy does find cancer, immediate treatment is only one option. Depending on the pathology and the wider clinical picture, active surveillance (regular monitoring with tests and scans) may be appropriate for some lower-risk cancers.
Biopsy decisions often depend on the full clinical picture: PSA trend, PSA density (PSA relative to prostate size), prostate volume, MRI findings, family history, age, prior biopsies, ancestry, symptoms, other health conditions and your preferences. Similar numbers can mean different things in different men.
If you have had a prostate MRI, it may help to ask your physician:
DeepView Imaging provides an AI-supported second analysis of a prostate MRI a man has already had, using ProstatID, AI software from Bot Image that is FDA-cleared, CE-Marked and UKCA-Certified and designed to assist physicians in assessing prostate MRI. It analyzes the T2-weighted, diffusion-weighted and ADC sequences, so it works with both biparametric (bpMRI) and multiparametric (mpMRI) scans, and returns a risk score with a color overlay highlighting suspicious areas. The goal is to give patients and their care team another perspective on information already contained within the MRI, which patients can share with their physician when discussing next steps. DeepView Imaging does not replace a radiologist, urologist or treating physician, and patient-management decisions should not be based solely on the AI output.
In less than a decade, pre-biopsy MRI use increased substantially. In the new study, nearly two-thirds of biopsy-naive patients had pre-biopsy MRI by the first half of 2026, although use still varied among patient groups. If a biopsy has been recommended for you, it is reasonable to ask whether an MRI is part of the plan, what it showed if you have had one, and how it is shaping the recommendation. Those decisions belong in a conversation with your care team.
This article is for educational purposes only and is not medical advice. Decisions about screening, biopsy, diagnosis, monitoring, or treatment should be made with your treating physician.
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