The UroOnc Minute: Biparametric vs multiparametric MRI for prostate cancer detection, with Veeru Kasivisvanathan, MBBS, MSc, PhD, FRCS

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, continues on-site coverage from 41st Annual European Association of Urology Congress in London, where he is joined by Veeru Kasivisvanathan, MBBS, MSc, PhD, FRCS, to discuss the role of biparametric vs multiparametric MRI (mpMRI) in the detection of clinically significant prostate cancer. Framing the conversation around real-world access challenges, Kasivisvanathan highlights a persistent gap in care—many patients who should receive MRI are still not getting one. This is largely due to the time, cost, and logistical burdens associated with traditional multiparametric imaging.

Drawing on findings from the PRIME study (NCT04571840), an international, multicenter trial, Kasivisvanathan explains that biparametric MRI, performed without contrast and in significantly less time, demonstrated noninferior cancer detection rates compared with standard mpMRI (29.2% vs 29.6%, respectively; difference, -0.4; 95% CI, -1.2 to 0.4; P = .50).¹ Importantly, omission of contrast had minimal impact on downstream clinical decision-making, influencing management in only a small minority of cases. These findings, he notes, support biparametric MRI as a potential new standard of care in appropriately selected settings, particularly when high-quality imaging and experienced radiologic interpretation are available. The discussion also underscores the patient-centered advantages of this approach, including shorter scan times and avoidance of gadolinium-based contrast, which many patients prefer.

Looking ahead, the conversation turns to implementation and future innovation. Kasivisvanathan emphasizes the importance of assessing local imaging quality and radiologist expertise when considering adoption, while also pointing to growing evidence supporting the generalizability of these findings beyond highly controlled trial settings. He also previews the upcoming PARADIGM trial, a large, international study evaluating artificial intelligence in prostate MRI interpretation.² By potentially enabling scalable, high-quality reads across diverse practice settings, AI-driven approaches may further expand access to accurate prostate cancer diagnostics, bringing the field closer to the goal of ensuring that every patient who needs an MRI can receive one.

REFERENCES

1. Ng AB, Asif A, Agarwal R, et al. Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis: The PRIME Diagnostic Clinical Trial. JAMA. 2025 Oct 7;334(13):1170-1179. doi:10.1001/jama.2025.13722

2. Ng AB, Giganti F, Kasivisvanathan V. Artificial Intelligence in Prostate Cancer Diagnosis on Magnetic Resonance Imaging: Time for a New PARADIGM. Eur Urol. 2025 Jul;88(1):4-7. doi:10.1016/j.eururo.2025.04.018