How to cite: Gamie SH. “Can Imaging Replace Biopsy in Selected Prostate Cancer Patients?” Grand Rounds in Urology. August 2026. Accessed Oct 2026. https://grandroundsinurology.com/can-imaging-replace-biopsy-in-selected-prostate-cancer-patients/
Summary
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, reviews the evolving role of advanced imaging in prostate cancer diagnosis. He explains that traditional pathways relying on elevated prostate-specific antigen (PSA) followed by systematic biopsy expose many patients to unnecessary procedures, sampling error, complications, and overtreatment while still failing to consistently identify clinically significant disease.
Dr. Gamie highlights multiparametric magnetic resonance imaging (mpMRI) as the current evidence-based first-line imaging modality endorsed by major professional societies. Dr. Gamie reviews how prostate imaging reporting and data system (PI-RADS) scoring guides clinical decision-making, with negative magnetic resonance imaging (MRI) studies often supporting biopsy avoidance, while higher PI-RADS scores facilitate targeted biopsy and improve detection of clinically significant prostate cancer. He emphasizes that MRI combines anatomical and functional imaging sequences to improve lesion characterization beyond what conventional structural imaging can provide.
Dr. Gamie next discusses prostate-specific membrane antigen positron emission tomography (PSMA PET) as an additional molecular imaging tool that refines patient selection, improves staging, and identifies disease not visible on MRI alone. Emerging evidence from the PRIMARY2 and Bologna studies suggests that PSMA PET may help identify selected high-risk patients who require biopsy despite negative MRI findings while also improving treatment planning and theranostic eligibility.
He also examines micro-ultrasound, highlighting results from the OPTIMUM trial that demonstrate diagnostic performance comparable to MRI-guided biopsy while offering lower cost, improved accessibility, and a single-visit workflow. Dr. Gamie argues that imaging modalities should be viewed as complementary rather than competing technologies. MRI remains the preferred initial diagnostic pathway, PSMA PET provides additional molecular characterization for selected patients, and micro-ultrasound expands access to targeted biopsy.
ABOUT THE AUTHOR
Sherief H. Gamie, MD, PhD, is the Chief and Director of the Nuclear/Molecular Imaging and Theranostics Program and Professor of Radiology at the University of California, San Diego, San Diego, California. Dr. Gamie specializes in nuclear medicine, with expertise in molecular imaging and theranostics, applying precision-targeted radiopharmaceuticals in the diagnosis and treatment of numerous malignancies.
