Biparametric MRI is emerging as a promising alternative to the standard multiparametric MRI for diagnosing prostate cancer. Unlike the traditional approach, it omits the use of gadolinium contrast, making the procedure shorter, cheaper, and easier to deliver. Findings from the PRIME trial suggest that this technique could soon become the new standard of care.
Rising demand for prostate cancer screening
“Currently around 4 million MRI scans are needed each year globally to diagnose prostate cancer. This demand is set to rise rapidly with a predicted surge in prostate cancer cases over the next 20 years,” explained Veeru Kasivisvanathan, PhD, principal investigator and associate professor at University College London. “If we can do the scan in up to half the time, with fewer staff and at lower cost, that will make a huge difference in allowing every man who needs a scan to get one in a timely fashion.”
Inside the PRIME trial
The study enrolled 490 men who had not previously undergone biopsy, across 22 clinical sites in 12 countries. All participants were suspected of having prostate cancer due to rising prostate-specific antigen (PSA) levels or abnormal digital rectal exam (DRE) findings. The median age was 65, and the median PSA level was 5.6 ng/mL.
Key findings
Both biparametric and multiparametric MRI scans were compared, with targeted biopsies confirming diagnoses. The main goal was to determine the rate of clinically significant prostate cancer. Results showed:
- Clinically significant prostate cancer was detected in 29.2% of men using biparametric MRI vs 29.6% with multiparametric MRI.
- Clinically insignificant cancer was found in 9.2% vs 9.6%, respectively.
- 99% of scans were rated as adequate for diagnostic quality.
These results demonstrated that biparametric MRI is noninferior to the standard method, meaning it works just as well for detecting clinically important cancers.
Implications for care
According to the authors, adopting biparametric MRI could substantially increase access to timely scans worldwide by lowering costs and reducing strain on healthcare systems. “Provided image quality is adequate, an abbreviated biparametric MRI scan could become the new standard of care,” they concluded.
What comes next?
Building on PRIME, the upcoming TRANSFORM trial will be the largest prostate cancer screening trial in two decades. Researchers aim to identify the safest, most effective, and most affordable way to screen men for prostate cancer, with results expected to support a national screening program in the UK.
Expert perspective
“The results from the PRIME trial, showing that a faster, cheaper type of prostate MRI is just as good as the current standard, are a hugely important step forward,” said Matthew Hobbs, PhD, research director at Prostate Cancer UK. “We encourage NICE to prepare to review their guidelines as soon as the full evidence is available, so that MRI can become quicker, cheaper, and less burdensome for men.”
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