# PRECISION: MRI-targeted or standard biopsy for prostate cancer diagnosis

Source: https://onco.cc/key-papers/paper-precision-mri-targeted-biopsy-nejm-2018/  
OnCo record `paper-precision-mri-targeted-biopsy-nejm-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Doing an MRI first and biopsying only suspicious areas found more clinically significant prostate cancers and fewer harmless ones than standard biopsy, while sparing a quarter of men any biopsy at all.

## Summary

Multicentre randomised non-inferiority trial of 500 biopsy-naive men with suspected prostate cancer randomised to MRI with targeted biopsy of suspicious lesions only (no biopsy if MRI was negative) or standard transrectal ultrasound-guided 10 to 12 core biopsy.

Clinically significant cancer was detected in 38 percent of the MRI group against 26 percent with standard biopsy, clinically insignificant cancer in 9 versus 22 percent, and 28 percent of MRI-group men avoided biopsy.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/NEJMoa1801993
- Authors: Kasivisvanathan V, Rannikko AS, Borghi M, et al.
- Findings: Clinically significant cancer detected in 38 percent vs 26 percent.; Clinically insignificant cancer in 9 percent vs 22 percent; 28 percent of MRI arm avoided biopsy.
- What it means: Pre-biopsy MRI with targeted sampling is now the standard diagnostic pathway for suspected prostate cancer, reducing overdiagnosis of low-risk disease.
- Caveats: Targeted biopsy alone may miss some significant cancers; many centres combine targeted and systematic cores.; Depends on MRI quality and reader expertise.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/NEJMoa1801993
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29552975/

## Connected records

- cancers: [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/)
- trials: [PRECISION](https://onco.cc/trials/precision-mri/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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