How to cite: Leapman MS. Should Prostate MRI Be the Primary Screening Approach? Grand Rounds in Urology. October 23, 2025. Accessed Apr 2026. https://grandroundsinurology.com/should-prostate-mri-be-the-primary-screening-approach/
Summary
Michael S. Leapman, MD, MHS, Associate Professor of Urology, Associate Professor of Chronic Disease Epidemiology, and Vice Chair of Research in the Department of Urology, Yale University, New Haven, Connecticut, examines whether prostate magnetic resonance imaging (MRI) should replace prostate-specific antigen (PSA) testing as the primary approach to prostate cancer screening. Dr. Leapman frames the discussion around limitations of PSA-based screening and presents a structured argument for an imaging-first paradigm, grounded in clinical cases and screening study data.
Dr. Leapman reviews key challenges of PSA screening, including trade-offs between sensitivity and specificity, biopsy burden, and over-detection. He then compares data illustrating the drawbacks of using conventional PSA-based approaches to studies demonstrating how using MRI as a screening modality improves the detection of clinically significant disease.
Dr. Leapman discusses important findings from population-based screening studies that illustrate MRI’s effectiveness, including a meta-analysis showing favorable numbers for screening and biopsy when using MRI as the primary screening test.
Dr. Leapman notes practical considerations, including accessibility, wait times, and the potential role of biparametric MRI in streamlining workflows and improving the feasibility of MRI-based screening.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques.
ABOUT THE AUTHOR
Michael S. Leapman, MD, is an Associate Professor of Urology, an Associate Professor of Chronic Disease Epidemiology, and Vice Chair of Research in the Department of Urology at Yale University in New Haven, Connecticut. Dr. Leapman also serves as the Clinical Lead for the Prostate and Urologic Cancer Program at the Yale Smilow Cancer Center, where he directs multidisciplinary efforts to improve the care of patients with prostate and other genitourinary cancers. His clinical practice is devoted to the management of prostate and other urologic malignancies, with a particular expertise in robotic and minimally invasive approaches to radical prostatectomy.
Dr. Leapman earned his medical degree from the University of Maryland in Baltimore. He completed an internship in General Surgery and a residency in Urology at Mount Sinai Hospital in New York, New York. Dr. Leapman then completed a fellowship in Urologic Oncology at the University of California, San Francisco. He earned his Master’s in Health Science from Yale University.
Dr. Leapman’s research focuses on questions related to how advanced imaging, biomarkers, and large-scale data analysis can be applied to improve detection, risk stratification, and management of prostate cancer, and ultimately to improve clinical outcomes. He has authored and co-authored more than 270 articles and book chapters in his field. He has been recognized for his contributions, including the John N. Forrest Jr. Prize for Mentorship in Student Research, Merit Award: Conquer Cancer Foundation of the American Society of Clinical Oncology, Best Poster: European School of Oncology Conference on Active Surveillance, and the First Place Essay, History Section: American Urological Association Western Section.
