If you are over 80 or have very high PSA levels, your doctor probably did not add an MRI before doing a prostate biopsy. That is reasonable clinical judgment.
It gets murky beyond that. Many patients will default to having everything if they look at their patient group and see it might help but that isn't evidence-based. What can be examined critically is why hospitals do and don't recommend it.
A recent analysis of over 505,000 prostate biopsies performed at US hospitals between January 2017 and June 2026 using the Epic Cosmos database found that men getting a first biopsy had prebiopsy MRI use rise from 14 percent in 2017 to 64 percent in the first half of 2026. Among men men who had a prior negative biopsy, use rose from 38 percent to 67 percent.
Clinical trials also warrant it, yet a third of men are not betting an MRI first, even though it may determine if a biopsy is needed. And where the needles should go.
It can't all be due to insurance companies. They have done the math and an MRI is far less expensive than biopsy, and doctors are aware of the literature. It may be the institutions between patients and insurance companies, though. University Hospitals Cleveland Medical Center tracks MRI and how it relates to biopsy outcomes while Kaiser in California, the semi-official provider of the state, may not.
Citation: Rhodes, S.; Basourakos, Spyridon P.; Jia, Angela Y.; Roy, Soumyajit; Spratt, Daniel E.; Ponsky, Lee; Shoag, Jonathan E.; et al. Trends in Prebiopsy MRI Utilization for Prostate Cancer Detection. JAMA Oncol. Published online September 17, 2026 doi:10.1001/jamaoncol.2026.3620
