Shifts in Diagnostic Approaches for Prostate Cancer: Impact of MRI‐Informed Biopsies on Low‐Risk Cancer Detection

Background With the shift in prostate cancer (PCa) diagnosis from systematic biopsies to magnetic resonance imaging (MRI)‐informed biopsies, we aimed to investigate the changing diagnostic practices of urologists and the impact of MRI on the detection of low‐risk PCa. Methods We conducted a retrospective analysis of 698 patients referred for PCa management at the Department of Urology, Kagawa University Hospital, between June 2014 and December 2023. Patients receiving dutasteride treatment ( n = 10) were excluded. We assessed longitudinal trends in patient age, PSA levels, utilization rates of digital rectal examination (DRE) and MRI, and the diagnosis of D'Amico low‐risk PCa. Predictive factors for low‐risk PCa diagnosis were also analyzed. Results The median age at diagnosis was 71 years (interquartile range [IQR], 66–76), and the median PSA level was 7.14 ng/mL (IQR, 5.29–12.07), both of which showed a significant upward trend over time (age: R 2 = 0.5687, p = 0.012; PSA: R 2 = 0.4076, p = 0.047). The frequency of DRE significantly decreased ( R 2 = 0.8306, p < 0.001), while MRI use increased significantly from 36.4% in 2014 to 92.1% in 2023 ( R 2 = 0.8960, p < 0.001). Concurrently, the proportion of D'Amico low‐risk PCa diagnoses declined from 22.7% in 2014 to 10.5% in 2023 ( R 2 = 0.6122, p = 0.008). Multivariate logistic regression revealed that MRI‐informed biopsies were significantly associated with a reduced likelihood of detecting low‐risk PCa (Odds ratio = 0.578, 95% confidence interval = 0.366–0.911, p = 0.018). Conclusion The increasing use of MRI‐informed biopsies in the diagnosis of PCa has shifted clinical practice, potentially contributing to the reduced detection of low‐risk PCa.