Nathanael R. Fillmore
Publications / 2026
paper
JAMA Oncology2026doi:10.1001/jamaoncol.2025.4167

Magnetic Resonance Imaging or Confirmatory Biopsy for Patients With Prostate Cancer Receiving Active Surveillance.

Matthew R. Cooperberg†, John R. Bihn†, John M. Culnan, Jennifer La, Sergey D. Goryachev, Daniel C. R. Chen, Oleg Soloviev, Grace Lee, June K. Corrigan, Kaitlin N. Swinnerton, Nicholas G. Nickols, Karlynn N. Dulberger, Pedro Barata, Rhonda L. Bitting, Mary T. Brophy, Heather H. Cheng, Hoedt Amanda De, Nhan V. Do, Stephen J. Freedland, Isla P. Garraway, J. Michael Gaziano, Susan Halabi, Richard L. Hauger, Stacy Loeb, David M. Nanus, Timothy R. Rebbeck, Matthew B. Rettig, Chong-Xian Pan, Kenute Myrie, Rachel B. Ramoni, Nathanael R. Fillmore‡, Channing J. Paller‡

† Equal first authorship · ‡ Equal senior authorship

Summary

Magnetic resonance imaging (MRI) failed to reliably rule out higher-grade prostate cancer in patients undergoing active surveillance, demonstrating a negative predictive value of only 75% at confirmatory biopsy. These findings suggest that MRI cannot yet replace confirmatory biopsies, as relying solely on imaging would lead to the underdiagnosis of clinically significant disease.

Key result

The negative predictive value of magnetic resonance imaging (PI-RADS ≤2) for ruling out grade group 2 or higher prostate cancer was 75% (95% CI, 66%-82%) at confirmatory biopsy and 77% (95% CI, 62%-87%) at surveillance biopsy.

Key figure

Key figure from Magnetic Resonance Imaging or Confirmatory Biopsy for Patients With Prostate Cancer Receiving Active Surveillance.