In this video, Veeru Kasivisvanathan, MBBS, BSc, FRCS, MSc, PGCert, PhD, discussed findings from the PRIME trial, a multicenter international study that provided level 1 evidence on the diagnostic performance of biparametric MRI (bpMRI) compared to multiparametric MRI (mpMRI) in prostate cancer detection.1 The study aimed to determine whether bpMRI, which omits the contrast-enhanced sequence, was noninferior to mpMRI in identifying clinically significant prostate cancer. Results demonstrated nearly identical detection rates—29% for both approaches—with only a 0.4% difference. Importantly, the omission of contrast did not increase diagnostic uncertainty, alter biopsy recommendations, or meaningfully affect treatment decision-making.
For practicing urologists, Kasivisvanathan emphasized that bpMRI, when performed with adequate image quality and interpreted by skilled radiologists, can be considered a new standard of care in the primary diagnostic setting. Clinically, this shift holds major practical implications. MRI access remains a significant barrier worldwide; for example, US data show only about one-third of biopsy-naïve men currently receive MRI before biopsy. By eliminating contrast, bpMRI offers a faster, more cost-effective option, making prostate MRI more accessible globally. With an estimated need for 4 million prostate MRIs annually, bpMRI has the potential to extend advanced imaging to men across diverse health care settings.
Ensuring consistent diagnostic quality remains critical. In the PRIME trial, 99% of scans were deemed adequate for diagnosis, a result achieved through rigorous quality assurance. Centers underwent pre-trial evaluation using the PI-QUAL scoring system, with protocol adjustments made where necessary to meet internationally recognized PI-RADS standards Kasivisvanathan stressed that each center should assess its MRI quality, make guideline-based refinements, and ensure interpretation by experienced radiologists. With these safeguards, the trial’s findings can be translated broadly, allowing bpMRI to improve diagnostic pathways for men with suspected prostate cancer worldwide.
REFERENCE
1. Ng ABCD, Asif A, Agarwal R, et al. Biparametric vs multiparametric MRI for prostate cancer diagnosis: The PRIME diagnostic clinical trial. JAMA. 2025 Sep 10:e2513722. doi:10.1001/jama.2025.13722