For men with PSA > 3.0, limiting biopsy to lesions seen on MRI appears to be safe

Clinical Question

In a prostate cancer screening program, is it possible to safely reduce the detection of clinically insignificant prostate cancers by only performing a biopsy of the most suspicious lesions seen on magnetic resonance imaging?

Bottom line

A strategy of only performing biopsies on lesions deemed suspicious on MRI, without systematic ("random") biopsies appears to safely find the more important cancers while reducing the total number of biopsies and potentially the need for active treatment or active surveillance. 1b

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Population-based


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discuss this POEM


Arup Kumar Dhara

Impact assessment


Roland Michael Grad

Doesn’t address the most important question

Considering this was done in a screening context: What is the mortality benefit of this invasive intervention?


Targeted biopsies of lesions

Targeted biopsy of lesions only as sensitive as full prostate biopsies for men with PSA <3



Working in Canada, using an MRI as part of the screening process isn’t a viable option due to wait times.


prostate ca