Adoption of MRI-guided Prostate Cancer Diagnostics and Surgical Outcomes: A Prospective Multicenter Registry Study

Adoption of magnetic resonance imaging (MRI)-guided prostate biopsy across different health care settings remains variable, and its implementation, following guideline endorsement, has not been fully characterized, particularly with respect to temporal trends and downstream surgical outcomes.

We analyzed biopsy techniques and postoperative outcomes among men undergoing radical prostatectomy (2020-2025), using the prospective national SWISS urology prostatectomy registry.

Temporal trends in MRI-guided versus non-MRI-guided biopsy were compared across university, regional, and local/private hospitals. Multivariable logistic regression models were used to evaluate associations between biopsy technique and pathological and perioperative outcomes.

A total of 7687 men from 29 centers were included. A rapid transition from non-MRI-guided to MRI-guided biopsy was observed over the study period. University hospitals were early adopters of MRI-guided biopsy, with use approaching 85% by 2020 and achieving complete adoption by 2024. Regional and local/private hospitals showed a more gradual increase, with MRI-guided biopsy rising from 44% in 2020 to 88% by early 2025. In multivariable analyses, MRI-guided biopsy was associated with lower risk of understaging (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.57-0.72; p < 0.001) and positive surgical margins (OR 0.80; 95% CI 0.70-0.92; p = 0.001), and was not associated with increased perioperative complications or International Society of Urological Pathology grade upgrading. Limitations include residual confounding and the selection of surgically treated patients.

MRI-guided biopsy rapidly became the dominant diagnostic approach, with academic centers leading adoption and other care settings converging thereafter, highlighting the important role of academic centers in implementing guideline-recommended diagnostics.