Risks & Benefits of the MRI-Pathway for Prostate Cancer Diagnosis

Learning objectives
To discuss whether the MRI pathway is leading to over-diagnoses and over-treatment despite its advantages over systemic biopsies
Benefits arise from true results (TP/TN) and harm from false results (FP/FN)
Harms mostly emanate from the highly variable false-positive rate of MRI
Before an MRI directed prostate biopsy, the likely benefits and the harms need to be weighed
Prioritizing patients’ preferences by their tolerance to potential harms are essential to assess
Strategies that maintain benefits while reducing the harms include (1) changing the MRI threshold for biopsy, (2) biopsy strategy adopted, and (3) histopathologic assessments