Use of prebiopsy prostate MRI increasing across US hospitals, study finds

Use of prostate magnetic resonance imaging (MRI) before biopsy increased across US hospitals between 2017 and the first half of 2026, according to a large retrospective analysis published in JAMA Oncology.¹

The findings provide a contemporary view of the adoption of MRI-based prostate cancer diagnostic pathways following a series of randomized trials and guideline changes supporting MRI before biopsy, particularly in men with a prior negative biopsy.

“This is a well- recognized national problem which to a certain extent has been related to access and issues with insurance coverage. I still regularly see patients biopsied at other institutions who did not have an MRI first, but the scope of the problem is, to a large extent, unknown,” said senior author Jonathan Shoag, MD, chief of the division of urologic oncology and director of the prostate cancer program at University Hospitals (UH), Cleveland, Ohio, in a news release on the results.² “The best prior data came from insurance claims through 2022 and suggested MRI was used in only about 30% of biopsies. We wanted a current, national picture: how many men are getting an MRI before biopsy today, and is everyone benefiting equally?”

Study tracks MRI adoption across more than 505,000 biopsies

The investigators analyzed more than 505,000 prostate biopsies performed at US hospitals between January 2017 and June 2026 using Epic Cosmos, an electronic health record database incorporating data from multiple health systems. The team examined trends in the use of prostate MRI before biopsy and evaluated utilization according to clinical characteristics.

Among men undergoing their first biopsy, the proportion who received an MRI before the procedure increased from 14% in 2017 to 64% in the first half of 2026. In the repeat-biopsy population, prebiopsy MRI use increased from 38% to 67% over the same period.

The authors noted that the increase occurred as evidence supporting MRI-based diagnostic pathways accumulated and professional guidelines increasingly incorporated MRI into prostate cancer evaluation.

“That is a genuinely rapid shift, and the timing tracks closely with the publication of the major trials and their results adoption into guidelines,” said lead author Stephen Rhodes, PhD, clinical research biostatistician at UH, in the news release.²

The investigators also identified variation in MRI utilization according to patient characteristics. Use decreased among men with very high prostate-specific antigen (PSA) levels and those older than 80 years. The study authors noted that lower utilization in these groups could reflect clinical circumstances in which MRI may be less likely to alter management, although the utilization analysis could not determine the reasons for individual clinical decisions.

REFERENCES

1. Rhodes S, Basourakos SP, Hu JC, et al. Trends in prebiopsy MRI utilization for prostate cancer detection. JAMA Oncol. 2026:e263620. doi:10.1001/jamaoncol.2026.3620

2. University Hospitals researchers find major increase in the use of MRI before prostate biopsy. News release. University Hospitals Cleveland Medical Center. September 18, 2026. Accessed September 21, 2026. https://news.uhhospitals.org/news-releases/articles/2026/09/university-hospitals-researchers-find-major-increase-in-the-use-of-mri-before-prostate-biopsy