Pre-biopsy magnetic resonance imaging (MRI) is recommended in prostate cancer diagnostics, but its impact on testing patterns and diagnostic outcomes on a population-level remains unclear.
Using the Stockholm Prostate Cancer Diagnostics Register, we conducted a population-based study of men aged ≥40 yr without prior prostate cancer during 2010-2023. We described the trends in prostate-specific antigen (PSA) testing, the proportion of men with PSA ≥3 ng/ml undergoing further testing (MRI and/or biopsy), and the distribution of biopsy outcomes.
PSA testing was stable over time, with greater uptake observed in older men: in 2023, 14-yr prevalence was 76% in men aged 60-69 yr, and 84% in both those aged 70-79 and ≥80 yr. Among men with PSA ≥3 ng/ml, MRI within 1 yr increased from 3% in 2010 to 30% in 2023, while the proportion undergoing prostate biopsy declined from 23% to 16% (relative risk [RR]: 0.71; 95% confidence interval [CI]: 0.69-0.73). By 2023, 83% of biopsied men had a pre-biopsy MRI. Over the study period, biopsy outcomes improved: detection of International Society of Urological Pathology [ISUP] grade group [GG] ≥2 cancers more than doubled (RR: 2.12; 95% CI: 1.99-2.27), whereas both benign biopsies (RR: 0.66; 95% CI: 0.62-0.69) and ISUP GG 1 (RR: 0.61; 95% CI: 0.54-0.69) declined markedly.
PSA testing remained prevalent, and pre-biopsy MRI use increased substantially. During this period, detection of significant cancer among biopsied men increased markedly while unnecessary biopsies and low-grade cancer findings decreased. This study provides real-world population-based data that are consistent with a trend toward increased precision in prostate cancer diagnostics in the era of MRI implementation.
European urology open science. 2026 Apr 04*** epublish ***
Jan Chandra Engel, Balram Rai, Martin Eklund, Fredrik Jäderling, Mark Clements, Tobias Nordström
Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden., Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.