MRI Staging Matches Digital Rectal Examination for Prostate Cancer Prognosis: JAMA
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2026-07-17 15:15 GMT | Update On 2026-07-17 15:16 GMT
France: Researchers have found in a new study of 4,425 men that MRI-based staging performed comparably to traditional digital rectal examination (DRE) in predicting prostate cancer outcomes, including biochemical recurrence-free and metastasis-free survival. MRI showed slightly higher accuracy, while both approaches demonstrated no significant difference in overall prognostic discrimination. With its non-invasive nature and more detailed anatomical information, MRI may be effectively integrated into modern prostate cancer staging pathways.
The findings, published in JAMA Network Open, are based on a multicenter retrospective case-control study led by Arthur Peyrottes from the Department of Urology, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Université Paris Cité, France, and colleagues. The study assessed whether MRI-based clinical T staging could provide prognostic accuracy comparable to conventional digital rectal examination (DRE)-based staging in men undergoing radical prostatectomy for localized or locally advanced prostate cancer.
Researchers analyzed data from the iTNM Consortium, including 4,425 men treated at 31 referral centers across six European countries between 2015 and 2021. All participants underwent preoperative multiparametric MRI and systematic prostate biopsies before radical prostatectomy. MRI-derived T stage was incorporated into four established risk classification systems—D'Amico, European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN), and the International Staging Collaboration for Prostate Cancer—and compared with traditional DRE-based staging.
The primary outcome was distant metastasis-free survival, while biochemical recurrence-free survival and overall survival were secondary outcomes. Prognostic performance was evaluated using the concordance index (C index) and time-dependent area under the receiver operating characteristic curve.
The following were the key findings:
- MRI-based staging showed slightly better accuracy than DRE-based staging in predicting biochemical recurrence-free survival (C index: 0.62 vs 0.59).
- MRI-based staging also demonstrated marginally better discrimination for distant metastasis-free survival (C index: 0.67 vs 0.65).
- Across all four established prostate cancer risk classification systems, MRI-based and DRE-based staging showed comparable prognostic performance, with overlapping 95% confidence intervals.
- Time-dependent analyses found no significant differences in predictive performance between MRI- and DRE-based staging throughout follow-up.
- Subgroup analyses of patients with clinical T1 disease and those with PSA levels below 10 ng/mL produced findings consistent with the overall results.
The researchers acknowledged that the retrospective design may have introduced selection bias and unmeasured confounding. Differences in MRI equipment, imaging protocols, radiologist expertise, and inconsistent pathological validation across centers may also have influenced the findings. Additionally, the median follow-up of nearly five years may not fully capture long-term outcomes.
The authors concluded that MRI-derived T staging provides prognostic accuracy comparable to conventional DRE-based staging and can be integrated into existing prostate cancer risk classification systems without compromising performance. They noted that future prospective studies incorporating radiomic and genomic data may further refine MRI-based risk assessment.
Reference:
Peyrottes A, Baboudjian M, Long-Depaquit T, et al. Performance of MRI-Based vs Clinical T Staging in Localized Prostate Cancer. JAMA Netw Open. 2026;9(7):e2623288. doi:10.1001/jamanetworkopen.2026.23288
Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.