The PSA blood test is the most efficient and least expensive way to screen the general population for prostate cancer. However, by itself it is not specific for prostate cancer. Now, a short MRI scan called biparametric MRI (bpMRI) is being investigated as a more precise first-line screening tool. As Dr. Dan Sperling says, “Imaging as a cancer-specific screening method would offer new hope in men’s health.”

Doesn’t the PSA test detect prostate cancer?

No, the PSA test does not specifically detect prostate cancer. A high level of prostate specific antigen (PSA) in the blood is a vague warning of a prostate problem. It could mean any of these:

• Benign prostatic hyperplasia (BPH), an aging-related enlargement of the gland
• An infection or inflammation, such as a urinary tract infection or prostatitis
• Recent sexual activity or other physical stimulation of the gland (e.g. bike riding)
• Even a digital rectal exam (DRE) right before the blood draw, which raises PSA levels
• And of course, prostate cancer.

Any one of these conditions can cause PSA to rise. Thus, a high PSA result does not automatically mean PCa. However, for lack of a better way to identify the exact cause of a rising PSA, doctors commonly referred the patient for a needle biopsy.

In turn, the conventional systematic but random sampling of prostate tissue often led to harm. This included under-diagnosing significant PCa, over-diagnosing insignificant PCa, and biopsy side effects. Furthermore, a negative (no cancer) biopsy meant the patient had been unnecessary.

As a Nov. 20, 2025 UroToday bulletin points out, “Prostate cancer (PCa) screening at the population level remains controversial, primarily because of concerns around overdetection and overtreatment.”

Did adding multiparametric MRI (mpMRI) improve the situation?

For men with a suspicious PSA, the situation was improved by adding multiparametric MRI (mpMRI) before biopsy. Following a high PSA, this intermediate step made it possible to rule biopsy need in or out. If the imaging session did not reveal an area suspicious for significant PCa, studies showed it was safe to avoid a biopsy but continue to monitor using PSA and MRI.^[i]

It is now becoming a standard of care to have an mpMRI before biopsy.^[ii]

Why not skip the blood test and use MRI to screen for prostate cancer?

The question of replacing PSA as a population screening tool and instead using imaging has been raised. mpMRI is considered the “optimal selection for the local staging of prostate cancer,”^[iii] but it’s expensive.

While some analyses have shown that mpMRI to detect prostate cancer before biopsy is cost-effective compared to the conventional PSA-to-biopsy pathway, replacing a cheap PSA test with mpMRI is not economically feasible.

According to one journal article, “MRI itself is costly, both in initial capital outlay and in cost of ongoing operations. While the added value of MRI in certain clinical circumstances is well established, the requirements for MRI unit, radiologist training, and relative value versus other approaches are all undergoing evaluation.”^[iv]

On a practical level, the three MRI imaging sequences (parameters) can take 35-45 minutes per scan. One sequence in particular requires injection of a contrast agent (Dynamic Contrast Enhanced MRI). Although this sequence adds information not gained by two other sequences, it ties up scanner time and adds cost. Also, not every patient is qualified for the type of contrast agent used.

Is there a shorter and less expensive MRI of the prostate?

Now, there is a faster and less expensive prostate MRI called biparametric MRI (bpMRI). It leaves out Dynamic Contrast Enhanced MRI. The PRIME diagnostic clinical trial showed bpMRI performance in detecting significant prostate cancer is non-inferior to mpMRI.^[v]

Typically, bpMRI sessions as little as 10-15 minutes and are more comfortable for the patient. With the addition of Artificial Intelligence/Deep Learning, even an ultrafast bpMRI under 5 minutes is possible.^[vi]

Could bpMRI be a first-line screening tool instead of the PSA test?

It may be possible in the not-too-distant future to replace the nonspecific PSA test with bpMRI. The hypothesis of bpMRI having a central role in population screening was proposed by a British team out of the Centre for Medical Imaging (University College London).^[vii]

Their hypothesis was tested on 303 randomly selected and screened using bpMRI. (Those whose scans were positive for suspicion of prostate cancer were then biopsied.) Based on their findings, the authors concluded, “Abbreviated bpMRI may have value in PCa screening independently of PSA testing.” They noted, however, that more multicenter testing would be needed to determine the “feasibility and cost-effectiveness” of national stand-alone bpMRI screening.

Can prostate cancer screening become more precise?

Studies like that done by the Centre of Medical Imaging offer hope that bpMRI could become an efficient and precise tool to screen entire populations for prostate cancer. At the Sperling Prostate Center, we eagerly follow such studies because we are equipped with a powerful 3T magnet and Artificial Intelligence software to be able to provide ultrafast bpMRI if it becomes a standard of screening.

Meanwhile, researchers are exploring specific biomarkers from blood, urine or tissue samples as another way to identify the presence of prostate cancer while it is still early and has no symptoms. Taken all together, it won’t be long before nonspecific PSA tests will be replaced with more precise screening.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Krüger-Stokke B, Bertilsson H, Langørgen S et al. Multiparametric Prostate MRI in Biopsy-Naïve Men: A Prospective Evaluation of Performance and Biopsy Strategies. Front Oncol. 2021 Oct 14;11:745657.
[ii] O'Shea A, Harisinghani M. PI-RADS: multiparametric MRI in prostate cancer. MAGMA. 2022 Aug;35(4):523-532. 
[iii] Oliveira T, Amaral Ferreira L, Marto CM et al. The Role of Multiparametric MRI in the Local Staging of Prostate Cancer. Front Biosci (Elite Ed). 2023 Sep 20;15(3):21.
[iv] Hutchinson R, Lotan Y. Cost consideration in utilization of multiparametric magnetic resonance imaging in prostate cancer. Transl Androl Urol. 2017 Jun;6(3):345-354.
[v] Ng ABCD, Asif A, Agarwal R, Panebianco V et al. Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis: The PRIME Diagnostic Clinical Trial. JAMA. 2025 Oct 7;334(13):1170-1179.
[vi] Pausch AM, Filleböck V, Elsner C et al. Ultra-fast biparametric MRI in prostate cancer assessment: Diagnostic performance and image quality compared to conventional multiparametric MRI. Eur J Radiol Open. 2025 Jan 21;14:100635.
[vii] Thorley N, Parry T, Giganti F, Kopcke D et al. Diagnostic accuracy of abbreviated biparametric MRI for prostate cancer screening: a prospective feasibility study (ReIMAGINE study). Eur Radiol. 2025 Aug 6.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.