Doctors typically prefer a detailed prostate MRI image to a prostate biopsy when confirming a cancer diagnosis. MRIs are much less invasive and require no downtime. If a biopsy is necessary, doctors typically use MRI images to help them target suspicious areas.

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Magnetic resonance imaging (MRI) tests and prostate biopsies are two of the most common and accurate methods used to confirm a diagnosis of prostate cancer.

An MRI uses strong magnets and radio waves to create detailed cross-sectional views of your prostate gland and the area around it. A biopsy is done by removing tissue from your prostate gland with a needle and analyzing the tissue for the presence of cancerous cells. These days, most biopsies are guided by pre-biopsy imaging and evaluation.

Your doctor may recommend an MRI, a biopsy, or both to confirm a prostate cancer diagnosis. But in many cases, a prostate MRI may be preferable to the more invasive biopsy procedure. This is especially true if you’re at high risk for side effects or complications from the procedure.

Read on to learn more about whether a prostate MRI is better than a prostate biopsy, the advantages of each procedure, how much each procedure costs, and more.

Prostate MRIProstate biopsy
Length of procedure30 to 60 minutesabout 20 minutes
Recovery periodnone24-48 hours
Side effects or complicationsnonesoreness, bleeding, blood in urine or stool, infection

An MRI is often considered a more accurate way to confirm a diagnosis of prostate cancer than a biopsy. A 2019 article in the Canadian Medical Association Journal suggests that MRIs are accurate in diagnosing prostate cancer 93% of the time — compared with only 48% for biopsies.

The level of detail provided by an MRI can also help visually differentiate prostate cancer from tumors, growths, or related conditions that may be affecting areas around the prostate, such as the bladder or the urethra.

A biopsy can’t necessarily detect issues around the prostate that can cause symptoms similar to prostate cancer. A biopsy also can’t tell a doctor how advanced prostate cancer is, while an MRI can show how far cancerous tissue may have spread beyond the prostate gland.

Prostate MRIs are also less invasive because they use imaging techniques rather than inserting a needle into your body to remove prostate tissue. This means that there’s no recovery time after an MRI.

A prostate MRI can detect other conditions that may be affecting the prostate, such as infections or benign prostatic hyperplasia (BPH) — which happens when the prostate becomes enlarged for reasons other than cancer. This can help you get treatment for these conditions without getting a possibly unnecessary biopsy.

A prostate MRI is a highly accurate tool that’s not invasive and requires minimal preparation and recovery. It’s also associated with very few risks. But, this technology is only used to help confirm a diagnosis of prostate cancer, not to screen for prostate cancer.

Even though a prostate MRI is highly accurate, your doctor will use other information to help inform their diagnosis, including your prostate-specific antigen (PSA) test and digital rectal exam (DRE) results.

An MRI can also be used during active surveillance of prostate cancer. If you have a confirmed prostate cancer diagnosis but aren’t currently treating it, routine MRIs can help you avoid routine DREs and biopsies. If you’re undergoing active surveillance, an MRI is often the preferred method of investigation after a significant or rapid rise in PSA.

A biopsy is somewhat accurate in detecting prostate cancer but usually isn’t used alone to confirm a diagnosis.

A biopsy also requires a lot of preparation, such as stopping medications and taking an enema, which can be disruptive. Prostate biopsies also carry more risks, such as infection.

Biopsies are also not typically performed on people over the age of 70. This is because the risks of the procedure may outweigh the benefits.

A doctor may recommend that you get a prostate MRI before you get a biopsy. If your results from a prostate MRI don’t indicate any signs of cancer, the doctor may not recommend a biopsy.

A 2017 study in The Lancet suggests that 27% of men who get a prostate MRI may be able to avoid a biopsy.

Research suggests that having an MRI before undergoing a biopsy can increase the accuracy of results from biopsies while also avoiding unnecessary biopsies when signs of cancer aren’t found during an MRI.

MRI-guided biopsy

A doctor may recommend that you have an MRI-guided biopsy.

This means that the doctor who performs the biopsy will use your MRI images to help target suspicious areas to sample.

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A 2021 study in the New England Journal of Medicine of over 12,000 men found that screening for a diagnosis of prostate cancer with an MRI first is more accurate than a biopsy alone. This study also suggested that MRI results that didn’t detect prostate cancer helped many people avoid unnecessary biopsies.

The MRI results also helped doctors identify cases of “clinically insignificant” prostate cancer, which is low-grade, slow-growing prostate cancer that’s not expected to cause any harm during your lifetime. Distinguishing these cases helps people avoid unnecessary treatment.

Fusion-guided biopsy

A fusion-guided biopsy is a new technique that relies on computer software that combines specialized MRI images taken before your biopsy with ultrasound images captured during the biopsy itself. Fusing these images together helps the doctor target specific areas of the prostate.

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The experience of getting an MRI is much different than getting a biopsy. Learn what to expect.

Prostate MRI

Here’s what to expect when you’re getting a prostate MRI:

  1. You likely won’t need to change any food or medications beforehand.
  2. When you arrive at a facility for an MRI, you’ll change into a hospital gown and lie on your side on a table connected to the MRI machine.
  3. A doctor may offer you a sedative to reduce anxiety if you’re anxious about being in the enclosed MRI tube.
  4. A doctor may place a small wire covered in latex called an endorectal coil into your rectum near the prostate to help make the images clearer.
  5. You may be injected with a contrast material or receive it in a vein (intravenously) to help make the MRI images clearer.
  6. You’ll slide into the MRI machine, where images are taken using strong magnets and radio waves. An MRI typically lasts from 30 to 60 minutes.
  7. You can usually go home immediately after an MRI unless you need time for the sedative to wear off.

Prostate biopsy

Here’s what to expect from a prostate biopsy:

  1. You’ll need to stop taking blood thinners or similar medications in advance of the procedure.
  2. You may need to provide a urine sample to make sure you don’t have a urinary tract infection (UTI). If you have a UTI, you’ll need to wait to do the biopsy until the UTI clears.
  3. You need to take an enema to help clear out your bowels.
  4. You may be asked to take antibiotics to reduce your risk of infection from the procedure.
  5. When you arrive at the facility for your biopsy, you’ll change into a hospital gown and lie on your side on a table.
  6. To take the biopsy, a doctor will insert a needle into your anus and then pierce the rectal wall to access the prostate and take a sample. Another approach is to make a small cut into the perineum to insert the needle through. The doctor may use an MRI to guide this second type of biopsy.
  7. You can usually go home right after a prostate biopsy. But you’ll need to avoid any strenuous activity for up to 48 hours, and you may have some soreness or bleeding.

How much does a prostate MRI or biopsy cost?

The cost of a prostate MRI or biopsy will vary based on your health insurance coverage, location, and the medical professional who performs the procedure.

These procedures are typically covered by insurance providers, so the amount you owe may depend on your co-pay or deductible. But here’s a general idea of the average costs for a prostate MRI or a biopsy for prostate cancer:

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There are several other screening tools that a doctor may use to help them make a diagnosis for prostate cancer, including:

  • PSA test: A sample of your blood is taken to look for levels of prostate-specific antigen (PSA) protein in your blood. Abnormally high levels can indicate the presence of prostate cancer. A rapidly rising PSA score can also indicate prostate cancer, even if the results are not elevated. This test is often used as a first-line diagnostic tool and to look for early signs of prostate cancer.
  • Digital rectal exam (DRE): A doctor inserts a gloved, lubricated finger into your rectum to feel for any unusual lumps or abnormal tissue around the area of your prostate. This exam is often done as part of a routine physical examination after you turn 50 years old (or 45 if you’re at a higher risk for prostate cancer).

A doctor may not recommend that you get a prostate MRI or biopsy if results from these two tests don’t show any concerning signs of prostate cancer. But an MRI or biopsy may be needed to confirm the results of a PSA test or DRE that indicates prostate cancer.

When you should see a doctor

Seek immediate medical attention if you notice any of the following symptoms:

  • peeing more frequently than usual
  • a stinging sensation when you pee
  • having trouble getting pee to come out
  • having a weak dribbling flow when you pee
  • blood in your pee
  • bloody or unusual discharge from your penis
  • unusual pain in your hips, lower back, pelvis, or upper thighs
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A prostate MRI is considered one of the most accurate tools for confirming a diagnosis of prostate cancer. It can also help prevent unnecessary biopsies by screening out people who may have no signs of prostate cancer.

In some cases, a prostate MRI may be used along with a biopsy or even to guide a biopsy to get an earlier and more accurate diagnosis.

If you’re between 45 and 50 years old or at high risk for prostate cancer, talk with a doctor about what screening tests you may need to help detect prostate cancer.