Diagnosis of Prostate Cancer: Can Imaging Replace Biopsy in Selected Patients? Dr. Sherief H. Gamie

In this presentation from the UroCancer Interdisciplinary Forum (UCIF) 2026, Sherief H. Gamie, MD, PhD, Professor of Clinical Radiology, UC San Diego Health, University of California, San Diego, San Diego, California, examines how multiparametric magnetic resonance imaging (mpMRI), prostate-specific membrane antigen positron emission tomography (PSMA PET), and micro-ultrasound are transforming the diagnostic pathway for prostate cancer. Dr. Gamie reviews the limitations of the traditional approach in which an elevated prostate-specific antigen (PSA) level routinely leads to systematic biopsy. Imaging-first strategies identify men who are most likely to benefit from biopsy while reducing unnecessary invasive procedures in patients with a lower likelihood of clinically significant disease. Dr. Gamie summarizes evidence supporting mpMRI as the recommended first-line imaging modality, discusses how PSMA PET adds molecular information that improves staging and identifies disease not detected by MRI alone, and reviews findings from the PRIMARY2 and Bologna studies evaluating imaging-guided patient selection. He also highlights results from the OPTIMUM trial demonstrating that micro-ultrasound provides diagnostic performance comparable to MRI-guided biopsy while offering a lower-cost, single-visit alternative that may improve access to targeted prostate imaging. Dr. Gamie emphasizes that MRI, PSMA PET, and micro-ultrasound should be viewed as complementary technologies rather than competing modalities. Although imaging continues to improve diagnostic accuracy and reduce unnecessary biopsies, biopsy remains the standard for confirming clinically significant prostate cancer before definitive treatment. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!