A groundbreaking clinical trial led by researchers from University College London (UCL), UCL Hospitals (UCLH), and the University of Birmingham has demonstrated that a significantly faster and more cost-effective MRI scan can diagnose prostate cancer with the same accuracy as the current standard procedure. This advancement has the potential to revolutionize prostate cancer diagnostics worldwide by making MRI scans more accessible to patients, reducing costs, and easing demand pressures on healthcare systems.
The PRIME trial, a large-scale randomized clinical study funded by the John Black Charitable Foundation and Prostate Cancer UK, was published recently in the prestigious medical journal JAMA. The trial compared traditional three-part multiparametric MRI (mpMRI) scans with an abbreviated two-part biparametric MRI (bpMRI) protocol. Remarkably, the shorter bpMRI scan reduces scan time from 30-40 minutes to just 15-20 minutes, eliminating the need for a contrast dye injection and reducing the requirement for clinical staff intervention during imaging.
MRI technology has transformed prostate cancer diagnosis during the past decade, enabling clinicians to visualize suspicious abnormalities within the prostate gland and better target biopsies to detect significant cancers while avoiding overdiagnosis of indolent disease. The mpMRI procedure typically includes three imaging sequences, one of which involves injecting a gadolinium-based contrast agent to highlight cancerous tissues. However, this contrast phase adds time, cost, and the rare risk of adverse reactions.
Despite the proven benefits of MRI in prostate cancer detection, many men eligible for this diagnostic test fail to receive it, often due to resource limitations in healthcare settings globally. Previous studies have shown that only about one-third of men diagnosed with prostate cancer in the United States underwent an MRI in 2022, while in England and Wales, just 62% of men requiring imaging received it in 2019. These gaps highlight an urgent need to streamline and expand access to prostate MRI.
The PRIME trial enrolled 555 men aged 59 to 70 from 22 hospitals spanning 12 countries, providing a robust and internationally representative dataset. Each participant underwent a full mpMRI scan encompassing all three imaging phases, followed by separate assessments of the shorter biparametric scan images without the contrast-enhanced stage. Subsequent biopsies were performed when clinically indicated to confirm diagnostic accuracy.
Results confirmed the two-part bpMRI scan matched the diagnostic sensitivity of the full mpMRI scan, detecting clinically important prostate cancer in 29% of cases in both scan groups. These findings suggest that the contrast-based third phase may be redundant in many clinical situations, offering an opportunity to safely reduce scan duration and eliminate the need for intravenous contrast without compromising diagnostic accuracy.
Dr Veeru Kasivisvanathan, the trial’s lead investigator from UCL Surgery & Interventional Science and UCLH, emphasized the implications of these findings, noting the global demand for approximately four million prostate MRI scans annually is expected to surge alongside increasing prostate cancer incidence. Reducing scan times and staffing requirements could address systemic bottlenecks, enabling hospitals to accommodate more patients and expedite diagnoses.
From a technical standpoint, the biparametric MRI leverages high-resolution T2-weighted and diffusion-weighted imaging sequences to detect suspicious lesions within the prostate. The omission of dynamic contrast-enhanced imaging streamlines workflow and removes a phase that requires the presence of medical staff, intravenous access, and adds patient discomfort. The study highlights the importance of ensuring that MRI interpretation is conducted by radiologists with specialized expertise in prostate imaging to maintain diagnostic precision.
Economically, the shorter biparametric scan carries substantial cost-saving potential. Within the UK National Health Service (NHS), the average cost of a full mpMRI prostate scan is approximately £273. The abbreviated bpMRI reduces this to £145 per scan, nearly halving expenditure. This reduction is expected to be even more impactful in healthcare systems with higher baseline imaging costs, such as in the United States, offering a financially sustainable pathway to expand prostate cancer diagnostic services.
Beyond accuracy and cost, the PRIME trial’s results also pave the way for broader systemic change. Prostate Cancer UK is preparing to launch the TRANSFORM trial, the largest prostate cancer screening study in two decades, which will incorporate MRI technology and aim to establish an evidence base for a national prostate cancer screening program. The PRIME findings are a crucial step toward optimizing the MRI component of such screening efforts, ensuring they are both effective and practical.
Dr Matthew Hobbs, Director of Research at Prostate Cancer UK, articulated the transformative potential of these findings, urging regulatory bodies such as NICE (National Institute for Health and Care Excellence) to update their guidelines to accommodate the biparametric MRI approach once further confirmatory evidence is available. Additionally, he encouraged hospitals to prepare adoption by adhering to updated scan quality protocols derived from UCL’s GLIMPSE trial recommendations.
The clinical implications of streamlining prostate MRI are multifaceted. Accelerated scan times mean more men can be served using the existing scanner infrastructure, addressing current disparities in imaging availability. Abandoning contrast-enhanced imaging reduces patient discomfort, minimizes rare risks associated with contrast agents, and decreases the complexity of the procedure. The overall effect is an improved patient experience coupled with enhanced diagnostic throughput.
This study also underscores a broader trend in medical imaging toward tailored, evidence-driven simplification that preserves or enhances diagnostic performance while alleviating logistical burdens. The PRIME trial model combining international collaboration, rigorous methodology, and clinically relevant endpoints exemplifies the pathway for driving practice-changing research in oncological diagnostics.
Future work will focus on further refining biparametric imaging protocols, ensuring reproducibility in diverse clinical environments, and integrating artificial intelligence and advanced image analytics to enhance radiological assessment. These innovations promise to elevate prostate cancer detection rates, reduce unnecessary biopsies, and ultimately improve patient outcomes through earlier and more precise diagnosis.
In summary, the PRIME trial provides compelling evidence that biparametric MRI is a viable, faster, and cost-efficient alternative to the standard multiparametric approach for detecting clinically significant prostate cancer. As the global burden of prostate cancer grows, adopting this streamlined imaging pathway could dramatically improve diagnostic accessibility and efficiency, setting the stage for transformative progress in men’s health worldwide.
Subject of Research: People
Article Title: Biparametric versus multiparametric MRI for prostate cancer diagnosis: The PRIME Diagnostic Clinical Trial
News Publication Date: 10-Sep-2025
Web References:
10.1001/jama.2025.13722 (DOI: http://dx.doi.org/10.1001/jama.2025.13722)
Keywords: Cancer; Prostate cancer; Medical imaging
