Multiparametric magnetic resonance imaging (mpMRI) is the reference modality for detecting clinically significant prostate cancer (csPC). Biparametric MRI (bpMRI), which omits contrast, has emerged as a streamlined alternative.
Recent studies have demonstrated the noninferiority of bpMRI to mpMRI for csPC detection in biopsy-naïve men. We performed an updated systematic review and meta-analysis of head-to-head studies comparing bpMRI and mpMRI for csPC detection, and conducted a noninferiority analysis.
Literature databases were searched up to September 2025 for head-to-head studies. Eligible studies enrolled men with suspected PC and used biopsy or prostatectomy as the reference standard. The primary outcome was diagnostic accuracy for csPC at per-patient and per-lesion levels; detection of any PC was a secondary outcome. Noninferiority was assessed using a margin of -5% applied to paired absolute differences (bpMRI - mpMRI) in sensitivity and specificity via a random-effects model.
A total of 40 studies (9403 patients) were analyzed. For csPC, the paired absolute differences were -2.3% (95% confidence interval [CI] -4.1% to -0.5%) for sensitivity, and +1.8% (95% CI -0.4% to +4.0%) for specificity, which confirm noninferiority at the patient level. At the lesion level, bpMRI was noninferior for specificity but not sensitivity, probably because of fewer studies and greater heterogeneity.
bpMRI is noninferior to mpMRI for csPC detection at the patient level. At the per-lesion level, noninferiority was demonstrated for specificity but not for sensitivity. Broader implementation should occur in settings with assured image quality, and further work is needed to define minimum quality-control standards required for adoption.
European urology. 2026 Feb 16 [Epub ahead of print]
Guilherme Strieder de Oliveira, Stephan Altmayer, Giovanni Brondani Torri, João Edson Prediger, Jorge Abreu-Gomez, Sangeet Ghai, Masoom A Haider, Caroline L A Ghezzi, Rubens G F Andrade, Andrea Ponsiglione, Giorgio Brembilla, Francesco Giganti, Aqua Asif, Alexander B C D Ng, Veeru Kasivisvanathan, Adriano B Dias
Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: ., Department of Radiology, Stanford University, Stanford, CA, USA., Department of Radiology, University of Florida, Gainesville, FL, USA., Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network - Sinai Health System - Women's College Hospital, University of Toronto, Toronto, Canada., Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Radiology, Hospital Moinhos de Vento, Porto Alegre, Brazil., Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Department of Internal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil., Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy., Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK., Division of Surgery and Interventional Science, University College London, London, UK; Centre for Urology Imaging, Prostate, AI and Surgical Studies (COMPASS) Research Group, Division of Surgery and Interventional Science, University College London, London, UK., Division of Surgery and Interventional Science, University College London, London, UK; Centre for Urology Imaging, Prostate, AI and Surgical Studies (COMPASS) Research Group, Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41702800