# PROMIS: diagnostic accuracy of multiparametric MRI and TRUS biopsy in prostate cancer

Source: https://onco.cc/key-papers/paper-ahmed-promis-multiparametric-mri-lancet-2017/  
OnCo record `paper-ahmed-promis-multiparametric-mri-lancet-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Every man with a raised PSA used to get a needle biopsy through the rectum, which misses half the serious cancers and can cause sepsis. This trial gave 576 men a scan, a standard biopsy and an exhaustive mapping biopsy, and showed the scan could safely spare a quarter of them the needle.

## Summary

Hashim Ahmed, Mark Emberton and the PROMIS study group ran a paired-cohort confirmatory study in which men with prostate-specific antigen up to 15 nanograms per millilitre and no previous biopsy had 1.5 Tesla multiparametric magnetic resonance imaging, then both transrectal ultrasound-guided biopsy and template prostate mapping biopsy as the reference standard, each read blind to the others.

The design is the point. Comparing a scan against the biopsy it is meant to replace tells you nothing, because the biopsy is itself inaccurate; PROMIS compared both against an exhaustive mapping biopsy. The result, that the scan is far more sensitive and far less specific than the standard biopsy, is what made magnetic resonance imaging a triage test rather than a confirmatory one, and PRECISION the following year showed the pathway works in practice.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Also known as: PROMIS; Ahmed 2017; PROMIS multiparametric MRI triage
- Tags: prostate-evidence
- Journal: The Lancet
- Year: 2017
- DOI: 10.1016/s0140-6736(16)32401-1
- Authors: Ahmed HU, El-Shater Bosaily A, Brown LC, et al.
- Findings: Of 576 men completing all three tests, 408 (71 percent) had cancer on template mapping biopsy and 230 (40 percent) had clinically significant cancer.; For clinically significant cancer, multiparametric magnetic resonance imaging was more sensitive than transrectal ultrasound-guided biopsy (93 percent, 95 percent confidence interval 88 to 96, against 48 percent, 42 to 55; p less than 0.0001).; Magnetic resonance imaging was less specific than the biopsy (41 percent, 36 to 46, against 96 percent, 94 to 98; p less than 0.0001).; Using the scan to triage might allow 27 percent of men to avoid a primary biopsy and diagnose 5 percent fewer clinically insignificant cancers, and could detect up to 18 percent more cases of clinically significant cancer if subsequent biopsies were directed by the scan.; 44 of 740 enrolled patients (5.9 percent) reported serious adverse events, including 8 cases of sepsis.
- What it means: The evidence that put a scan in front of the biopsy. It reduces the number of men who are biopsied at all, reduces the number of harmless cancers found, and increases the number of dangerous ones, which is the only combination that improves a screening pathway on both sides at once.
- Caveats: Clinically significant cancer was defined as Gleason 4+3 or above, or a maximum cancer core length of 6 mm or more; a different definition changes the accuracy figures.; 1.5 Tesla imaging read by expert radiologists in a trial setting; accuracy in routine services depends on scanner, protocol and reader, which is the argument for per-centre audit.; Template mapping biopsy is the best available reference standard but is not perfect, and 8 cases of sepsis in the study are a reminder that the reference standard has harms of its own.

## Sources

- Lancet 2017: https://doi.org/10.1016/s0140-6736(16)32401-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28110982/
- ClinicalTrials.gov NCT01292291: https://clinicaltrials.gov/study/NCT01292291

## Connected records

- key papers: [Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging](https://onco.cc/key-papers/paper-johnson-mpmri-individual-foci-eur-urol-2019/), [PRECISION: MRI-targeted or standard biopsy for prostate cancer diagnosis](https://onco.cc/key-papers/paper-precision-mri-targeted-biopsy-nejm-2018/), [Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only](https://onco.cc/key-papers/paper-goteborg-2-n-engl-j-med-2022/)
- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Imaging](https://onco.cc/fronts/imaging/)
- technologies: [MRI](https://onco.cc/technologies/mri/), [PSA and MRI-first prostate cancer screening](https://onco.cc/technologies/prostate-screening-psa-mri/)
- institutions: [University College London Hospitals / UCL Cancer Institute](https://onco.cc/institutions/uclh/)
- terms: [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/), [PI-RADS (Prostate Imaging Reporting and Data System)](https://onco.cc/terms/pi-rads/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Screening](https://onco.cc/terms/screening/), [Template mapping biopsy (transperineal template prostate mapping)](https://onco.cc/terms/template-mapping-biopsy/), [Whole-mount pathology](https://onco.cc/terms/whole-mount-pathology/)
- people: [Mark Emberton](https://onco.cc/people/mark-emberton/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)
- ideas: [Publish a per-lesion miss rate for every prostate MRI service before it is allowed to guide focal treatment](https://onco.cc/ideas/idea-prostate-per-lesion-mri-audit-before-focal-treatment/)

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