Detection of prostate cancer by magnetic resonance imaging before biopsy – real-world evidence from a nationwide cohort study
DOI:
https://doi.org/10.2340/sju.v61.46161Keywords:
Biopsy, multiparametric magnetic resonance imaging, population surveillance, prostatic neoplasmsAbstract
Objective: Magnetic resonance imaging (MRI) improves prostate cancer detection, but some tumours may be undetectable. This study assessed prostate cancer detection in biopsy-naïve men undergoing first-time prostate MRI.
Material and methods: In this nationwide Danish cohort (2018–2022), men aged ≥ 40 years undergoing first-time prostate MRI were classified as MRI-positive if biopsied within 30 days, and MRI-negative if not. This served as a proxy for the radiology report findings. One-year cumulative incidence of prostate cancer diagnosis in the Danish Prostate Cancer Registry, repeated MRI, biopsy and mortality was estimated by MRI-status (positive/negative) and prostate-specific antigen (PSA) level, using the Aalen–Johansen estimator. Occurrence of high-grade cancer was also assessed.
Results: Among 10,777 men, 40% were MRI-positive and 60% MRI-negative. The cumulative incidence of prostate cancer was higher in the MRI-positive than the MRI-negative men during 1-year follow-up (63% vs. 5% at PSA levels 2–3.9 µg/L), increasing with higher PSA levels (91% vs. 38% at PSA levels ≥ 20 µg/L). At 1 year, repeated MRI occurred in 21% of MRI-positive men and 9% of MRI-negative men; the subsequent 1-year biopsy incidence was 15% among MRI-negative men. Mortality was comparable between MRI-positive and MRI-negative men (1% vs. 1%). The risk of high-grade prostate cancer at the time of diagnosis was 80% in MRI-positive and 74% in the MRI-negative men.
Conclusions: Among biopsy-naïve men undergoing first-time prostate MRI, MRI-positive status strongly predicts prostate cancer, even in men with low PSA. In MRI-negative men with PSA < 4.0 µg/L, prostate cancer risk remains low within the 2-year follow-up.
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References
Bergengren O, Pekala KR, Matsoukas K, et al. 2022 update on prostate cancer epidemiology and risk factors – a systematic review. Eur Urol. 2023;84:191–206. DOI: https://doi.org/10.1016/j.eururo.2023.04.021
Borre M, Elversang J, Hansen S, et al. The Danish Prostate Cancer Database annual report 2024. Aarhus: the Danish Healthcare Quality Institute; 2025.
Jahnen M, Hausler T, Meissner VH, et al. Predicting clinically significant prostate cancer following suspicious mpMRI: analyses from a high-volume center. World J Urol. 2024;42(1):290. DOI: https://doi.org/10.1007/s00345-024-04991-6
Nakai H, Takahashi H, LeGout JD, et al. Estimated diagnostic performance of prostate MRI performed with clinical suspicion of prostate cancer. Insights Imaging. 2024;15(1):271. DOI: https://doi.org/10.1186/s13244-024-01845-y
Wimper Y, Fütterer JJ, Bomers JGR. MR imaging in real time guiding of therapies in prostate cancer. Life. 2022. Feb 17;12(2):302 DOI: https://doi.org/10.3390/life12020302
Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer – 2020 update. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79:243–262. DOI: https://doi.org/10.1016/j.eururo.2020.09.042
Wysock JS, Mendhiratta N, Zattoni F, et al. Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results. BJU Int. 2016;118(4):515–520. DOI: https://doi.org/10.1111/bju.13427
Goldberg H, Ahmad AE, Chandrasekar T, et al. Comparison of magnetic resonance imaging and transrectal ultrasound informed prostate biopsy for prostate cancer diagnosis in biopsy naïve men: a systematic review and meta-analysis. J Urol. 2020 Jun;203(6):1085–1092. DOI: https://doi.org/10.1097/JU.0000000000000595
Guo E, Xu L, Zhang D, et al. Diagnostic performance of MRI in detecting prostate cancer in patients with prostate-specific antigen levels of 4–10 ng/mL: a systematic review and meta-analysis. Insights Imaging. 2024;15(1): 147. DOI: https://doi.org/10.1186/s13244-024-01699-4
Wibmer AG, Lefkowitz RA, Lakhman Y, et al. MRI-detectability of clinically significant prostate cancer relates to oncologic outcomes after prostatectomy. Clin Genitourin Cancer. 2022;20(4):319–325. DOI: https://doi.org/10.1016/j.clgc.2022.04.001
Hugosson J, Godtman RA, Wallstrom J, et al. Results after four years of screening for prostate cancer with PSA and MRI. N Engl J Med. 2024;391(12):1083–1095. DOI: https://doi.org/10.1056/NEJMoa2406050
Padhani AR, Godtman RA, Schoots IG. Key learning on the promise and limitations of MRI in prostate cancer screening. Eur Radiol. 2024 Sep;34(9): 6168–6174. DOI: https://doi.org/10.1007/s00330-024-10626-6
Diez NG, de Pablos-Rodríguez P, Sánchez-Mateos Manzaneque D, et al. Can we rely on magnetic resonance imaging for prostate cancer detection and surgical planning? Comprehensive analysis of a large cohort of patients undergoing transperineal mapped biopsies. World J Urol. 2024;42(1):548. DOI: https://doi.org/10.1007/s00345-024-05233-5
Nguyen-Nielsen M, Høyer S, Friis S, et al. The Danish prostate cancer database. Clin Epidemiol. 2016 Oct;25:8:649–653. DOI: https://doi.org/10.2147/CLEP.S100256
Statistics Denmark. StatBank Denmark [Population] [Internet]. 2023 [cited 2025 Sep 10]. Available from:
Frank L. Epidemiology. When an entire country is a cohort. Science. 2000;287(5462):2398–2399. DOI: https://doi.org/10.1126/science.287.5462.2398
Schmidt M, Pedersen L, Sorensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014;29(8):541–549. DOI: https://doi.org/10.1007/s10654-014-9930-3
Schmidt M, Schmidt SA, Sandegaard JL, et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–490. DOI: https://doi.org/10.2147/CLEP.S91125
Dansk Prostata Cancer Database (DaProCa) – RKKP [Internet]. [cited 2023 May 16]. Available from: https://www.rkkp.dk/kvalitetsdatabaser/databaser/dansk-prostata-cancer-database/
Grann AF, Erichsen R, Nielsen AG, et al. Existing data sources for clinical epidemiology: The clinical laboratory information system (LABKA) research database at Aarhus University, Denmark. Clin Epidemiol. 2011;3:133–138. DOI: https://doi.org/10.2147/CLEP.S17901
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. DOI: https://doi.org/10.1016/0021-9681(87)90171-8
Arafa MA, Rabah DM, Khan F, et al. False-positive magnetic resonance imaging prostate cancer correlates and clinical implications. Urol Ann. 2023;15(1):54–59. DOI: https://doi.org/10.4103/ua.ua_22_22
Cheng Y, Fan B, Fu Y, et al. Prediction of false-positive PI-RADS 5 lesions on prostate multiparametric MRI: development and internal validation of a clinical-radiological characteristics based nomogram. BMC Urol. 2024;24(1):76. DOI: https://doi.org/10.1186/s12894-024-01465-0
Ventimiglia E, Gedeborg R, Westerberg M, et al. Nationwide population-based longitudinal data on magnetic resonance imaging of the prostate and subsequent prostate biopsy results. Scand J Urol. 2026;61:64–71. DOI: https://doi.org/10.2340/sju.v61.45540
Carter HB. Prostate cancers in men with low PSA levels – must we find them? N Engl J Med. 2004;350(22):2292–2294. DOI: https://doi.org/10.1056/NEJMe048003
Bociański J, Sklinda K, Walecki J, et al. A case of high-grade prostate cancer with low PSA levels. Urol Case Rep. 2025 Aug 16;62:103161.
Obiora D, Orikogbo O, Davies BJ, et al. Controversies in prostate cancer screening. Urol Oncol. 2025 Jan;43(1):49–53. DOI: https://doi.org/10.1016/j.urolonc.2024.06.022
Oh CU, Kang H. The effectiveness and harms of PSA-based prostate cancer screening: a systematic review. Healthcare. 2025. Jun 9;13(12):1381 DOI: https://doi.org/10.3390/healthcare13121381
Mahase E. Is the UK really ready to roll out prostate cancer screening? BMJ. 2023 May 17;381:p1062. DOI: https://doi.org/10.1136/bmj.p1062
Vickers A, O’Brien F, Montorsi F, et al. Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit. BMJ. 2023 May17;381:e071082. DOI: https://doi.org/10.1136/bmj-2022-071082
Fazekas T, Shim SR, Basile G, et al. Magnetic resonance imaging in prostate cancer screening. JAMA Oncol. 2024;10(6):745. DOI: https://doi.org/10.1001/jamaoncol.2024.0734
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