Dec. 15, 2025 — For decades, when tests suggested that a man might have prostate cancer, the next step was usually a biopsy.
The procedure, where a doctor uses a thin needle to collect prostate tissues for testing under a microscope, is still the gold standard for diagnosis, but recent scientific advances have given certain patients the chance to learn more before undergoing one.
Men with high prostate-specific antigen (PSA) scores may now first get a pre-biopsy magnetic resonance imaging (MRI) test that can help doctors see prostate tissue in fine detail so they can then perform a more accurate biopsy, or even avoid one.
"MRI is a more sensitive detection tool that improves our ability to identify clinically significant cancers that might have been missed with traditional biopsy approaches," said Michael Leapman, MD, associate professor of urology at Yale. "At the same time, it can reduce the chance of diagnosing very low-risk cancers that may not need treatment."
The American Urological Association and European Association of Urology recommends pre-biopsy MRIs, and they’re growing in popularity. In 2007, just 0.5% of U.S. men receiving a prostate biopsy got an MRI first, according to a study published in the journal Prostate Cancer and Prostatic Diseases, but by 2022, that number grew to 35.5%.
Not everyone has the same level of access, however. Pre-biopsy MRI use is growing faster in urban areas than in rural areas. Fortunately, researchers are working on ways to make the tests more accessible.
Here's what you need to know about pre-biopsy MRIs for detecting prostate cancer and when you should get one.
How Pre-Biopsy MRI Works
MRIs use magnetic fields and radio waves to produce detailed images of tissues inside the body. For checking prostates, doctors use multiparametric MRI, a combination of three MRI techniques that captures water movement and blood flow in prostate tissue and differentiates between normal tissue and cancer.
During the test, the patient slides into a tubular MRI scanner, and they often receive an injection of a contrast agent, a dye that makes images clearer.
Prostate cancer is the second-leading cause of cancer death in American men. Research suggests that pre-biopsy MRIs can help doctors pinpoint the cancers that are likely to grow and spread fast and reduce overdiagnosis of those that are unlikely to spread.
That's important because cancer treatments can have significant side effects, such as urinary or sexual difficulties, that are well worth the risk when the cancer is aggressive, but less so in cases of small, slow-growing tumors that would never have spread in a man's lifetime.
Eric Kim, MD, associate professor of surgery at the University of Nevada, Reno, said pre-biopsy MRI is especially helpful in cases where a man has an elevated but not sky-high PSA level. If your PSA is 20 or more, your odds of cancer are high. But if your PSA is between, say, 3 and 10? It's less clear whether cancer or another factor is driving the number up.
"The first decision is: Should I consider a biopsy? Yes or no?" Kim said. "MRI shouldn't be the single tool that tells you that answer — that should be a combination of your family history, your clinical risk, and how many prostate or urinary symptoms you have."
If you decide to get a biopsy, he said, then you really should consider a high-quality MRI that can show your doctor where to stick the needle to find suspected cancer and reduce your risk of misdiagnosis.
"The biggest leap for prostate cancer diagnosis in the last 10 years is that MRI substantially, time and time again, improves the biopsy sampling or biopsy yield," Kim said.
The benefits could add up for patients and health systems. In 2024, researchers in the United Kingdom, where pre-biopsy is more common than in the United States, studied the effects of its soaring popularity at a major hospital.
By 2018, 88% of men with suspected prostate cancer received an MRI before biopsy, compared to just 10% in 2009. As pre-biopsy MRI became more common, doctors diagnosed more clinically significant cases of prostate cancer, 49% versus 29%, while their negative biopsy rate dropped from 52% to 34%.
The adoption of pre-biopsy MRI had financial benefits too, with a cost savings to the U.K. health system of 86,000 pounds (about $115,000) per year, according to the study.
How Do You Get a Pre-Biopsy MRI?
If your PSA is elevated and your doctor recommends a biopsy, ask about a pre-biopsy MRI, suggests Leapman.
"MRI is not always needed in every case, but it is certainly a valuable option worth discussing as part of shared decision-making," he said. In fact, he adds, it might even spare you from having a biopsy at all.
Then you need to find a doctor who’s up to date on pre-biopsy MRI and other tests that have hit the market in the last 10 to 15 years for use between PSA and biopsy, said Kim.
The FDA has approved blood and urinary biomarker tests that detect proteins and genes associated with prostate cancer. Their results can help your doctor figure the probability that cancer is present, which can aid decisions about how to proceed.
"Ask in a very polite and gentle way about things like biomarkers and imaging,” Kim said. “Their key core knowledge about those things can help you suss out if that provider is up to speed."
If they're not? Book a virtual consultation at an academic medical center, he suggests. And if you decide to get a pre-biopsy MRI, schedule a test somewhere where the team has experience and the right equipment to do them well.
"Make sure you're getting your MRI done at a reputable place that does a high volume of MRIs," Kim said. He recommends looking up or asking about the resolution of the MRI scanner at your medical center. A 3-Tesla machine provides a better image quality than the 1.5-Tesla machines you’ll find at some community hospitals.
"If you're a patient, it's probably worth traveling a little bit just to get on a machine of higher quality," he said.
Blood or urine biomarker tests for prostate cancer could help you decide whether the trek is worth it, especially if you live in a remote area.
"Compared to MRI, which may be difficult to access, these tests can be accessed anywhere FedEx goes," said Kim.
What's Next for Pre-Biopsy MRI?
In a recent study, Leapman's team found that pre-biopsy MRI use was lower in rural or less affluent areas compared to urban or wealthier regions.
What makes the findings especially notable, he said, is that the entire population studied had private health insurance, which covers these services better than other types.
"This suggests that the differences we observed are not only about coverage, but also reflect broader issues such as local availability of MRI scanners, specialist referral patterns, and comfort with ordering and interpreting MRI," Leapman said.
Pre-biopsy MRI technology could become less expensive and more accessible in coming years. New research published in JAMA and the World Journal of Urology suggests that a simpler prostate MRI technique that doesn't require a contrast agent, known as biparametric MRI, is as effective at spotting prostate cancer as the more multiparametric MRIs used now.
Artificial intelligence could also give clinicians an assist. Kim's recent research, published in The Journal of Urology, suggests that applying AI models to diffusion basis spectrum imaging, an advanced MRI technique, could potentially help reduce unnecessary biopsies.
"I think this type of stuff is the future, because then you've eliminated or reduced the variability that the radiologist brings to the table by having some objective evaluation of the imaging data," said Kim. "But this is still, I think, a long way away."
