A study published in JAMA compares the use of biparametric vs multiparametric MRI for prostate cancer diagnosis.
Prof Freddie Hamdy, Nuffield Professor of Surgery and Professor of Urology, University of Oxford, and Prof Jenny Donovan, Professor of Social Medicine, University of Bristol, said:
“The PRIME study shows that biparametric MRI allows a rate of prostate cancer detection which is non-inferior to the conventional longer and more expensive multiparametric MRI. Additional limitations are clearly mentioned by the authors.
“What concerns us most is that the endpoint was the diagnosis of “clinically significant disease”, defined as Gleason Grade Group 2 or higher. This definition is increasingly questioned as being flawed because it still represents overdiagnosis in many cases, which in turn leads to overtreatment.
“Secondly, although the study evaluated biparametric MRI in staging and planning treatment, and reassuringly showed differences in favour of mpMRI in a minority of cases, it is possible that once the diagnosis is made with biparametric MRI, many centres with less expertise will continue to request a further multiparametric MRI to guide treatment decisions. This would represent an increased cost and burden to health systems and would need to be monitored and investigated further in addition to addressing training issues, quality control, health economics and developing the potential role of AI in the future mentioned by the authors.
“Thirdly, while an interesting development and step forward in the evolving prostate cancer diagnostic pathway, the study must be interpreted cautiously and should not be used to justify the argument for the adoption of screening because of the continuing overdiagnosis of the disease.
“It is also a pity that the press release from UCL does not reflect the hesitancy of the authors in the actual paper about the relevance of the findings. The authors themselves provide a long list of limitations related to the study design (not randomised, selected patient group, biases from order of tests, no economic evaluation, etc etc) that lead to their heavily caveated conclusion that these results ‘could’ contribute to changes in practice. However, the press release does not highlight all these caveats and uncertainties and so could lead to reporting that does not reflect the state of the evidence on introducing two-part MRI in prostate cancer diagnosis or screening”.
Mr Ben Lamb, Consultant Urological and Robotic Surgeon, Barts Health and UCLH NHS Trusts, and Clinical Senior Lecturer, Barts Cancer Institute, Queen Mary University of London (QMUL), said:
“This is a high quality study that adds important evidence about the safe and effective assessment of men at risk of prostate cancer.
“The study design is pragmatic- they are not trying to show that bpMRI is superior, just that it’s not significantly worse, than mpMRI. This is important because mp-MRI requires an injection of contrast, which in a few patients could be potentially hazardous due to allergic reactions and it therefore requires the presence of a clinician such as a doctor to supervise the procedure. Moreover the contrast enhanced sequences which are performed after the injection. Add more time to the scan which means fewer scans can be done in a day.
“With an eye on the future and the scaling up of prostate cancer risk assessment for more men in the population increased MRI capacity will be needed with the exact number depending on the outcomes of the national screening committee findings and also the findings of the national screening trial TRANSFORM which will soon begin. By parametric MRI has the potential benefits of allowing more scans to be performed on any scanner in a given time and read deployment of valuable NHS resources such as doctors who would not be needed to be present for all the scans.
“Without doubt, the current advice on assessing men’s prostate cancer risk and PSA testing needs to be revised. However, we should not rush into a national screening program without carefully considering the most effective way of doing it, and also the impact of resource allocation on other areas of healthcare. The current study provides important data on how to best utilise resources and is an important contribution to the debate.
“This evidence comes from a high-quality clinical trial with the caveat that it may not be representative of normal clinical practice across the UK. advances have been made in the quality and consistency of MRI scanning across the country, but variability still remains and clinical trial evidence cannot always be reproduced in real world practice.”
‘Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis: The PRIME Diagnostic Clinical Trial’ by Alexander B.C.D. Ng et al. was published in JAMA at 16:00 UK time Wednesday 10 September 2025.
DOI: 10.1001/jama.2025.13722
Declared interests
No reply to our request for DOIs was received.