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Prostate Cancer

The check-up centre offered me a prostate MRI. Is it worth paying for?

In 618 Korean men who did exactly that, testing PSA first would have made nine out of ten of the scans unnecessary — and missed one cancer out of nine.

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On the Korean evidence it is usually not worth scanning before a PSA test: among 618 asymptomatic Korean men with a median age of 61 who had a prostate MRI at a health check-up without prior PSA testing, 9 (1.5 percent) were found to have clinically significant cancer and 57 were biopsied without finding any — and because 8 of those 9 cancers occurred in men with a PSA above 3.0 ng/mL, checking PSA first and scanning only those men would have avoided 90.0 percent of the scans, 69.9 percent of the biopsy consultations and 70.2 percent of the biopsies that found nothing, at the cost of missing one case.

Key takeaways

  • 618 asymptomatic Korean men, median age 61, had a prostate MRI at a health check-up with no prior PSA test.
  • Their median PSA, drawn at the same visit, was 0.98 ng/mL.
  • 535 men (86.6 percent) had a normal scan and none of them was biopsied.
  • 83 men (13.4 percent) had a suspicious scan, 66 were biopsied, and 9 (1.5 percent) had clinically significant cancer.
  • 8 of the 9 significant cancers occurred in men with a PSA above 3.0 ng/mL.
  • A PSA-first pathway would have avoided 90.0 percent of the scans and 70.2 percent of the biopsies that found nothing, while missing one case.
  • Among the 442 men who fit standard screening-trial criteria, a PSA-first pathway would have missed none of five significant cancers.

Scanning first sounds more thorough than a blood test, and in research settings in North America and Europe upfront MRI for prostate cancer has looked promising. This is what happened when a Korean centre did it on men who had walked in for a health check.

What 618 scans produced

9 cancers, 57 negative biopsies

outcome of upfront prostate MRI in 618 asymptomatic Korean men at a health check-upJoo Y et al., AJR, 2026

More than six men were biopsied and found not to have significant cancer for every man in whom one was found. A prostate biopsy is not a trivial procedure — it carries bleeding and infection risk and is uncomfortable — so those 57 are a real cost, not a bookkeeping entry.

The number that explains the result

The median PSA in this group was 0.98 ng/mL. Most of the men being scanned had no biochemical reason to be scanned at all, which means the MRI was looking for disease in a population where it was very unlikely to be present. In that setting any test generates more false alarms than findings — not because the test is bad, but because of how few cancers there are to find.

Why the Korean setting matters

The authors conclude that the upfront-MRI pathway is inefficient in Korean men having general health evaluations and that conventional PSA-gating should continue. Their broader point is that population-level differences should be weighed carefully before applying trial results elsewhere — and Korean national data shows roughly half of prostate cancer here is high risk at diagnosis, a very different detection profile from the populations those trials ran in.

The practical version: ask for a PSA test first. If it is raised, the MRI becomes a good test rather than a fishing expedition. This is a single centre and a self-selected group who chose and paid for the scan, so it is not the last word — but 618 men had it done, and what it cost them is on the record.

Sources

  1. 1

    Joo Y, Tse JR, Yoon J, Jung DC, Oh YT, Park JH

    Upfront Biparametric MRI for Prostate Cancer Screening: Experience in 618 Korean Men Outside of a Clinical Trial Setting

    AJR: American Journal of Roentgenology 2026

    doi:10.2214/AJR.26.35694 · PMID:42776580

    https://doi.org/10.2214/AJR.26.35694