MRI use prior to prostate biopsy after guideline recommendation in Canada

Results from northern Alberta

Authors

  • Jacob Bennett Division of Urology, Department of Surgery, University of Alberta
  • Tarana A. Mangukia University of Alberta
  • Eden Philips Division of Urology, Department of Surgery, University of Alberta
  • Riya Mangukia Division of Urology, Department of Surgery, University of Alberta
  • Tark Patel Division of Urology, Department of Surgery, University of Alberta
  • Parsa Babaei Zadeh Division of Urology, Department of Surgery, University of Alberta
  • Melis Guer Department of Urology, University Hospital Tübingen, Tübingen, Germany
  • Adam Kinnaird Division of Urology, Department of Surgery, University of Alberta

DOI:

https://doi.org/10.5489/cuaj.9701

Keywords:

Prostate Cancer Screening, MRI, Prostate Biopsy

Abstract

Introduction: Implementation of magnetic resonance imaging (MRI) prior to a prostate biopsy has improved detection of clinically significant prostate cancer, while reducing overdiagnosis of low-risk disease. Accordingly, the Canadian Urological Association (CUA) updated its prostate screening guidelines to recommend MRI prior to prostate biopsy in biopsy-naive men in 2022. This study aims to assess real-world implementation of pre-biopsy MRI by urologists in accordance with CUA guidelines.

Methods: We conducted a retrospective, observational cohort study of all men undergoing prostate biopsy from April 2022 to April 2024 in Edmonton, AB, Canada. Data was extracted from a province-wide electronic medical record. Inclusion criteria were biopsy-naive men with a prostate-specific antigen (PSA) ≤20 ng/ml. Statistical analysis completed using Chi-squared and two-proportioned z-tests.

Results: A total of 2626 men underwent prostate biopsy during the study period and 1491 participants met the inclusion criteria; 1054 (71%) received MRI prior to biopsy, with a median wait time to MRI of 101 days (interquartile range [IQR] 30–164). Inclusion of MRI in the diagnostic pathway was significantly associated with a longer interval from initial urology consultation to prostate biopsy (208 vs. 52 days, p<0.0001). Use of MRI resulted in fewer benign pathology results (12% vs. 23%, p<0.00001) and increased detection of grade group ≥2 (73% vs. 59%, p<0.00001) compared to those who did not receive MRI.

Conclusions: Approximately seven of every 10 men undergo pre-biopsy MRI, which is markedly higher than the rate that has previously been identified in North America. Furthermore, MRI introduces a delayed time to biopsy but may reduce unnecessary prostate biopsies.

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Published

2026-10-19

How to Cite

Bennett, J., Mangukia, T. A., Philips, E., Mangukia, T., Patel, T., Babaei Zadeh, P., … Kinnaird, A. (2026). MRI use prior to prostate biopsy after guideline recommendation in Canada: Results from northern Alberta. Canadian Urological Association Journal, 21(2). https://doi.org/10.5489/cuaj.9701

Issue

Vol. 21 No. 2 (2027): CUAJ February

Section

Original Research

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