Can PSA Blood Tests Help Determine Who Needs an MRI?

Many men undergo an MRI after a prostate biopsy fails to detect cancer, but PSA levels remain elevated. However, MRI scans are expensive and are not always necessary.

Researchers studied more than 250 men who previously had a negative prostate biopsy to determine whether additional PSA measurements could identify those most likely to benefit from MRI.

They found that several PSA-related measurements—including PSA density and the ratio of free PSA to total PSA—helped predict which men were more likely to have clinically significant prostate cancer.

Using these blood test results to decide who should undergo MRI could reduce the number of MRI scans by about one-quarter while missing relatively few significant cancers.

Although additional research is needed, these findings suggest that carefully selected PSA measurements may help physicians use MRI more efficiently while reducing unnecessary testing.

Nature. January 2026.