When Looking for Prostate Cancer, Which Is Best, MRI or Biopsy?
Doctors typically prefer a detailed prostate MRI image to a prostate biopsy when confirming a cancer diagnosis. MRIs are much less invasive and require no downtime. If a biopsy is necessary, doctors typically use MRI images to help them target suspicious areas.
Magnetic resonance imaging (MRI) tests and prostate biopsies are two of the most common and accurate methods used to confirm a diagnosis of prostate cancer.
An MRI uses strong magnets and radio waves to create detailed cross-sectional views of your prostate gland and the area around it. A biopsy is done by removing tissue from your prostate gland with a needle and analyzing the tissue for the presence of cancerous cells. These days, most biopsies are guided by pre-biopsy imaging and evaluation.
Your doctor may recommend an MRI, a biopsy, or both to confirm a prostate cancer diagnosis. But in many cases, a prostate MRI may be preferable to the more invasive biopsy procedure. This is especially true if you’re at high risk for side effects or complications from the procedure.
Read on to learn more about whether a prostate MRI is better than a prostate biopsy, the advantages of each procedure, how much each procedure costs, and more.
| Prostate MRI | Prostate biopsy | |
| Accuracy | 93% | 48% |
| Preparation | minimal | substantial |
| Length of procedure | 30 to 60 minutes | about 20 minutes |
| Recovery period | none | 24-48 hours |
| Side effects or complications | none | soreness, bleeding, blood in urine or stool, infection |
An MRI is often considered a more accurate way to confirm a diagnosis of prostate cancer than a biopsy. A 2019 article in the Canadian Medical Association Journal suggests that MRIs are accurate in diagnosing prostate cancer 93% of the time — compared with only 48% for biopsies.
The level of detail provided by an MRI can also help visually differentiate prostate cancer from tumors, growths, or related conditions that may be affecting areas around the prostate, such as the bladder or the urethra.
A biopsy can’t necessarily detect issues around the prostate that can cause symptoms similar to prostate cancer. A biopsy also can’t tell a doctor how advanced prostate cancer is, while an MRI can show how far cancerous tissue may have spread beyond the prostate gland.
Prostate MRIs are also less invasive because they use imaging techniques rather than inserting a needle into your body to remove prostate tissue. This means that there’s no recovery time after an MRI.
A prostate MRI can detect other conditions that may be affecting the prostate, such as infections or benign prostatic hyperplasia (BPH) — which happens when the prostate becomes enlarged for reasons other than cancer. This can help you get treatment for these conditions without getting a possibly unnecessary biopsy.
A prostate MRI is a highly accurate tool that’s not invasive and requires minimal preparation and recovery. It’s also associated with very few risks. But, this technology is only used to help confirm a diagnosis of prostate cancer, not to screen for prostate cancer.
Even though a prostate MRI is highly accurate, your doctor will use other information to help inform their diagnosis, including your prostate-specific antigen (PSA) test and digital rectal exam (DRE) results.
An MRI can also be used during active surveillance of prostate cancer. If you have a confirmed prostate cancer diagnosis but aren’t currently treating it, routine MRIs can help you avoid routine DREs and biopsies. If you’re undergoing active surveillance, an MRI is often the preferred method of investigation after a significant or rapid rise in PSA.
A biopsy is somewhat accurate in detecting prostate cancer but usually isn’t used alone to confirm a diagnosis.
A biopsy also requires a lot of preparation, such as stopping medications and taking an enema, which can be disruptive. Prostate biopsies also carry more risks, such as infection.
Biopsies are also not typically performed on people over the age of 70. This is because the risks of the procedure may outweigh the benefits.
A doctor may recommend that you get a prostate MRI before you get a biopsy. If your results from a prostate MRI don’t indicate any signs of cancer, the doctor may not recommend a biopsy.
A 2017 study in The Lancet suggests that 27% of men who get a prostate MRI may be able to avoid a biopsy.
Research suggests that having an MRI before undergoing a biopsy can increase the accuracy of results from biopsies while also avoiding unnecessary biopsies when signs of cancer aren’t found during an MRI.
MRI-guided biopsy
A doctor may recommend that you have an MRI-guided biopsy.
This means that the doctor who performs the biopsy will use your MRI images to help target suspicious areas to sample.