University Hospitals researchers find major increase in the use of MRI before prostate biopsy

• In 2026, two thirds of men undergoing a first prostate biopsy underwent an MRI beforehand
• Any man facing a biopsy should be asking whether an MRI is appropriate for him, because it changes both whether a biopsy is needed and where the needles go
• Researchers saw MRI use fall off in men with very high PSA levels and in men over 80, which may reflect reasonable clinical judgment in some cases, but is worth examining rather than assuming
• MRI use increasing is a good thing, but there are still real gaps and issues with MRI quality

CLEVELAND -- Using prostate MRI before a biopsy is a real advance in prostate cancer diagnosis. Multiple randomized trials have shown that imaging the prostate first, and then targeting suspicious lesions, finds more of the aggressive cancers that matter. As a result, guidelines have progressively strengthened their recommendations for MRI.

What hasn’t been studied, though, is whether that evidence had changed recent practice. A new study released September 17, in Jama Oncology offers new information.

Researchers and the UH Urology Institute’s lead Clinical Research Biostatistician Stephen Rhodes, looked at more than 505,000 prostate biopsies performed at US hospitals between January 2017 and June 2026, using Epic Cosmos, a database drawn from electronic health records across many health systems. Among men getting a first biopsy, prebiopsy MRI use rose from 14% in 2017 to 64% in the first half of 2026. For men who had a prior negative biopsy, where the evidence for MRI was established earliest, use rose from 38% to 67%.

“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 Rhodes.

Practical takeaways

• A third of men undergoing a first prostate biopsy are still not getting an MRI beforehand.
• Any man facing a biopsy should be asking whether an MRI is appropriate for him, because it changes both whether a biopsy is needed and where the needles go.
• For health systems, there is a measurable quality gap. You can audit your own MRI rates by patient group and act on what you find.
• Researchers saw MRI use fall off in men with very high PSA levels and in men over 80, which may reflect reasonable clinical judgment in some cases, but is worth examining rather than assuming.
• MRI use increasing is a good thing, but there are still real gaps and issues with MRI quality.

“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. 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?” said senior author Jonathan Shoag, MD, Chief of the Division of Urologic Oncology and Director of the Prostate Cancer Program at UH.

“At University Hospitals, we have really invested in rigorously tracking our MRI quality and performance, and how it relates to biopsy outcomes. We have established workflows for giving patients access to the latest and greatest technology and biopsy techniques, like the transperineal approach. We were actually part of the clinical trials that established this as a standard, and have built a program to offer this with sedation to all our patients,” explained Dr. Shoag. “We were also one of the first to really adopt MRI and make it accessible to all our patients, and we are currently involved in multiple studies testing new tools to improve prostate cancer diagnosis.”

“As we've expanded access to advanced prostate cancer diagnostics, we've also worked to streamline the patient journey,” said Dr. Shoag. “Our prostate program helps navigate patients with elevated PSA levels through evaluation and decision-making, while our point-of-service scheduling initiative ensures imaging and follow-up appointments before patients leave the office. By combining early detection, personalized navigation, and improved access to care, we're helping patients move more efficiently from concern to diagnosis and, when necessary, treatment.”

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Rhodes, S.; Basourakos, Spyridon P.; Jia, Angela Y.; Roy, Soumyajit; Spratt, Daniel E.; Ponsky, Lee; Shoag, Jonathan E.; et al. Trends in Prebiopsy MRI Utilization for Prostate Cancer Detection. JAMA Oncol. Published online September 17, 2026. doi:10.1001/jamaoncol.2026.3620