Upfront Biparametric MRI for Prostate Cancer Screening: Experience in 618 Korean Men Outside of a Clinical Trial Setting
In brief
PSA-triggered screening would avoid 90% of upfront MRIs in Korean men
In this single-center study of 618 asymptomatic Korean men, upfront MRI identified nine cases of clinically significant prostate cancer. A simulated PSA-triggered approach would have avoided 90% of MRI scans and about 70% of biopsies that found no significant cancer, while missing one case. The findings are observational and may not apply to other populations or screening settings.
- Journal
- AJR. American journal of roentgenology (Q1)
- Published
- 23 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yohan Joo, Justin Ruey Tse, Jongjin Yoon, Dae Chul Jung, Young Taik Oh, Jae Hyon Park
- PMID
- 42776580
- DOI
- 10.2214/AJR.26.35694
Why clinicians should know about it
- Picked for Urology (top studies of the week, 18 October 2026): Upfront biparametric MRI screening for prostate cancer
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 18 October 2026): Upfront biparametric MRI prostate screening study
Abstract
Background: Literature supporting MRI for upfront prostate cancer screening in lieu of a traditional PSA-triggered strategy has been performed primarily within clinical trial settings in North American and European populations. Objective: To describe a single center's experience in performing upfront MRI for PCa screening in Korean men outside of a clinical trial setting. Methods: This retrospective study included 618 asymptomatic Korean men (median age, 61 years) who voluntarily underwent prostate biparametric MRI (bpMRI) from June 2024 to April 2026 as part of a health check-up program. Examinees lacked prior PSA testing and underwent such testing during the same visit as the bpMRI examination. Examinees assessed as PI-RADS ≥3 underwent consultation for biopsy. Outcomes were compared with a simulated PSA-triggered pathway, presuming bpMRI was performed only in examinees with PSA >3.0 ng/mL. Sensitivity analysis was performed in the subset of examinees who would have been eligible for the PROSA randomized trial comparing upfront-MRI and PSA-triggered screening (i.e., men 49-69 years old or ≥40 years old with a prostate cancer family history). Results: The 618 examinees had a median PSA of 0.98 ng/mL. A total of 535/618 (86.6%) examinees were assessed as PI-RADS 1 or 2, none of whom underwent biopsy. A total of 83/618 (13.4%) examinees were assessed as PI-RADS ≥3, 66/618 (10.7%) underwent biopsy, and 9/618 (1.5%) were diagnosed with clinically significant prostate cancer (csPCa). Sixty-two examinees, and eight of nine examinees with csPCa, had PSA >3.0 ng/mL. A simulated PSA-triggered pathway would have avoided 90.0% (556/618) of bpMRI examinations, 69.9% (58/83) of biopsy consultations, and 70.2% (40/57) of performed biopsies without csPCa, at expense of missing one examinee with csPCa. In the PROSA-eligible subset (n=442), the PSA-triggered pathway would have avoided 89.4% (395/442) of bpMRI examinations, 68.2% (45/66) of biopsy consultations, and 66.0% (31/47) of performed biopsies without csPCa, without missing any of five cases of csPCa. Conclusion: The findings indicate inefficiency of the upfront-MRI pathway in Korean men undergoing general health evaluations and support continued use of conventional PSA-gating screening in this population. Clinical Impact: Population-level differences should be carefully considered before extrapolating trial results to other settings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.