Faster 15-minute prostate MRI matches standard scan in landmark trial, study finds

A shortened 15- to 20-minute prostate MRI that omits contrast dye was as effective as the conventional 30- to 40-minute scan at detecting clinically important prostate cancer in a large international trial, researchers reported.

The PRIME trial, involving 555 men aged 59 to 70 from 22 hospitals in 12 countries, found that a two-part “biparametric” MRI identified significant prostate cancer in 29 percent of participants — the same rate as the current three-part “multiparametric” MRI that includes an injected contrast stage. The shorter scan required fewer staff, halved average cost and took up to half the time of the standard scan, the authors said.

Researchers from University College London and University College London Hospital said the biparametric scan could expand access to MRI for men suspected of having prostate cancer, easing capacity constraints that limit uptake in parts of the UK. In England and Wales only 62 percent of men who needed a prostate MRI received one in 2019, the most recent year with available data, the study noted.

"Currently around four million MRI scans are needed each year globally to diagnose prostate cancer. This demand is set to rise rapidly with a predicted surge in prostate cancer cases over the next 20 years," said Associate Professor Veeru Kasivisvanathan, chief investigator on the trial. "If we can do the scan in up to half the time, with fewer staff and at lower cost, that will make a huge difference in allowing every man who needs a scan to be able to get one in a timely fashion."

The three-part multiparametric MRI, introduced widely over the past decade, has been credited with improving prostate cancer detection while sparing many men from unnecessary biopsies; roughly one-third of patients have normal MRI results and can avoid biopsy. On the NHS, the typical three-part scan takes 30 to 40 minutes and costs an average of £273, the trial report said. The biparametric approach typically takes 15 to 20 minutes and was 47 percent cheaper in the trial analysis.

Associate Professor Francesco Giganti, a lead radiologist on the trial, said removing the contrast stage reduces the need for a clinician to administer dye and lowers the small risk of related side effects. "Being able to make accurate diagnoses without the contrast stage will reduce scan time meaning we can offer scans to more men using the same number of scanners and operators," he said, while stressing the importance of optimal image quality and interpretation by experienced prostate MRI radiologists.

The PRIME trial was funded by the John Black Charitable Foundation and Prostate Cancer UK and is published in JAMA, the Journal of the American Medical Association. Independent experts and advocacy groups said the findings could prompt changes in clinical practice and support efforts to develop an evidence-based screening programme for prostate cancer.

Prostate Cancer UK is preparing a separate large screening study, the Transform trial, due to start later this year and described as the largest prostate screening trial in two decades. Dr Matthew Hobbs, director of research at Prostate Cancer UK, said the PRIME results and the planned Transform trial together should provide the evidence needed to consider broader adoption of expedited MRI approaches and for guideline bodies such as NICE to review practice.

Calls for a national prostate screening programme have gained political traction. Health Secretary Wes Streeting told MPs in April he would like the NHS to proactively offer tests to men, starting with those at higher risk. Former prime minister Rishi Sunak and other senior politicians have also expressed support for targeted screening initiatives.

The UK National Screening Committee, which advises the government on which screening programmes to offer, is reviewing recent advances in prostate cancer diagnosis and is due to report its conclusions later this year. Prostate cancer remains the most common cancer in men in the UK, with about 56,000 diagnoses and 12,000 deaths annually.