The NICE 2019 guideline recommends mpMRI as the first-line investigation for men with suspected localised prostate cancer

The 2019 guideline recommends mpMRI as the first-line investigation for people with suspected localised prostate cancer. [1] Compared with TRUS biopsy, mpMRI is significantly better at identifying clinically significant prostate cancer, it can also reduce the number of men having biopsies unnecessarily and help improve the accuracy when taking biopsy samples, targeting directly any suspicious areas seen on the MRI. [2]

New 2019 NICE prostate cancer diagnosis and management guideline [1]
Assessment and diagnosis: Magnetic resonance imaging and biopsy

* A Likert scale is a graduated scale reflecting the degree of agreement or disagreement to given questions; for example, there may be five possible responses: strongly agree, agree, don’t know, disagree, or strongly disagree.

Biopsy may be omitted if mpMRI Likert score is 1–2 (section 1.2.4). Men with raised PSA but negative MRI scan and/or biopsy now have specific management guidelines, as detailed in sections 1.2.12 and 1.2.13 of the 2019 NICE guideline.

mpMRI, multiparametric magnetic resonance imaging; NICE, National Institute for Health and Care Excellence.

References:

1. National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management (update). NICE, 2019. www.nice.org.uk/guidance/gid-ng10057/documents/draft-guideline (last accessed 21/3/2019)
2. Prostate Cancer UK. mpMRI before biopsy can radically improve diagnosis. https://prostatecanceruk.org/about-us/projects-and-policies/mpmri