Prostate gland divided, representing visible and hidden complexities in cancer diagnosis.

Decoding Prostate Cancer: Why MRI Alone Isn't the Full Story

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Cutting-edge research reveals how genomic testing and traditional biopsies are still crucial in detecting aggressive tumors."

For years, doctors have relied on systematic transrectal ultrasound (TRUS) biopsies to detect prostate cancer. However, these biopsies aren't perfect. They can miss tumors or misclassify their aggressiveness. To improve accuracy, multiparametric magnetic resonance imaging (mpMRI) has emerged as a valuable tool.

MpMRI creates detailed images of the prostate, helping doctors target suspicious areas for biopsy. Some experts even propose using mpMRI as a first step, skipping systematic biopsies altogether for men with negative results. The idea is that tumors missed by mpMRI are generally low-risk. But is this always the case?

A recent study dives deep into the genomic characteristics of prostate tumors, comparing those visible on mpMRI with those that aren't. The results may surprise you: mpMRI alone might not be enough to catch all clinically significant cancers.

The mpMRI Blind Spot: What the Scans Can Miss

Prostate gland divided, representing visible and hidden complexities in cancer diagnosis.

The study, published in European Urology Oncology, challenges the assumption that mpMRI can replace traditional biopsies. Researchers analyzed tissue samples from men undergoing radical prostatectomies (surgical removal of the prostate). They looked at both mpMRI-visible and non-visible lesions, examining their genomic, epigenomic, and transcriptomic features.

The findings revealed that some tumors missed by mpMRI harbored genetic alterations commonly seen in advanced, metastatic prostate cancer. This suggests that these “hidden” tumors could be more aggressive than previously thought.

Intratumor Heterogeneity: Even within mpMRI-visible lesions, there was significant variation in genomic characteristics. This means that a single biopsy might not accurately represent the entire tumor.
Aggressive Alterations: Some mpMRI-nonvisible tumors had deletions in genes related to tumor suppression and DNA repair, including MAP3K7, FOXO3, MSH3, ERCC8, and RPC1. Case 6 had a Gleason score of 4 + 3 (case 6#5) cancer with copy number changes including RB1 and TP53 loss, as well as MYC amplification, which are commonly seen in mCRPC [42].
Risk of Misclassification: Relying solely on mpMRI could lead to misclassification of a patient’s risk and potentially inappropriate treatment decisions.

The study's lead authors emphasize that while mpMRI is a valuable tool, it shouldn't be the only factor guiding diagnosis. Systematic biopsies still play a crucial role in detecting aggressive tumors that might be missed by imaging alone.

The Future of Prostate Cancer Diagnosis: A Combined Approach

These findings highlight the complexity of prostate cancer and the need for a multi-faceted approach to diagnosis. Relying solely on mpMRI could lead to missed opportunities for early intervention in aggressive cases.

The researchers suggest that combining mpMRI with systematic biopsies and genomic testing offers the most comprehensive assessment of a patient's risk. This allows doctors to tailor treatment plans based on the unique characteristics of each individual's cancer.

As research continues, the hope is to refine these diagnostic strategies further, improving early detection and ultimately leading to better outcomes for men with prostate cancer.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.euo.2018.08.005, Alternate LINK

Title: Genomic Evaluation Of Multiparametric Magnetic Resonance Imaging-Visible And -Nonvisible Lesions In Clinically Localised Prostate Cancer

Subject: Urology

Journal: European Urology Oncology

Publisher: Elsevier BV

Authors: Marina A. Parry, Shambhavi Srivastava, Adnan Ali, Alessio Cannistraci, Jenny Antonello, João Diogo Barros-Silva, Valentina Ubertini, Vijay Ramani, Maurice Lau, Jonathan Shanks, Daisuke Nonaka, Pedro Oliveira, Thomas Hambrock, Hui Sun Leong, Nathalie Dhomen, Crispin Miller, Ged Brady, Caroline Dive, Noel W. Clarke, Richard Marais, Esther Baena

Published: 2019-02-01

Everything You Need To Know

What is the purpose of systematic transrectal ultrasound (TRUS) biopsies in prostate cancer diagnosis, and why is it important?

The primary role of systematic transrectal ultrasound (TRUS) biopsies is to detect prostate cancer by taking tissue samples. Traditionally, doctors have relied on these biopsies for diagnosis. The significance lies in its ability to directly sample the prostate tissue, providing a physical confirmation of the presence of cancerous cells. However, the systematic nature of these biopsies can result in missing tumors or misclassifying their aggressiveness, highlighting the need for improvements.

What is multiparametric magnetic resonance imaging (mpMRI), and how does it help in prostate cancer diagnosis?

Multiparametric magnetic resonance imaging (mpMRI) is a diagnostic tool that creates detailed images of the prostate to help doctors identify suspicious areas for biopsy. Its importance stems from its ability to visualize the prostate, potentially allowing for targeted biopsies of concerning areas. The study indicates that some aggressive tumors are missed by mpMRI. Therefore, it should not be the only factor in guiding a diagnosis, as it may lead to missing clinically significant cancers.

Why is relying solely on mpMRI for prostate cancer diagnosis potentially problematic?

The study's findings underscore that mpMRI alone might not be sufficient to catch all clinically significant prostate cancers. Some tumors not visible on mpMRI were found to have genetic alterations common in advanced, metastatic prostate cancer. This has significant implications because it suggests that relying solely on mpMRI could lead to misclassification of a patient’s risk and potentially lead to inappropriate treatment decisions.

What is intratumor heterogeneity, and why is it important in the context of prostate cancer?

Intratumor heterogeneity refers to the genomic variation within a single tumor. This means that different parts of the same tumor can have different genetic characteristics. The significance is that a single biopsy might not accurately represent the entire tumor, potentially leading to an incomplete understanding of the cancer's aggressiveness and its implications for treatment and prognosis. It could mean that some areas of the tumor are more aggressive than others.

What is the best approach to prostate cancer diagnosis, according to the findings?

The key takeaway is that a combined approach, integrating multiparametric magnetic resonance imaging (mpMRI), genomic testing, and systematic biopsies is crucial. Relying solely on mpMRI could miss aggressive tumors that require early intervention. A multi-faceted approach ensures comprehensive detection and accurate risk assessment, leading to more informed treatment decisions and improved patient outcomes. The study emphasizes that systematic biopsies still play a crucial role in detecting aggressive tumors that might be missed by imaging alone.