Scan reduces need for invasive prostate biopsies

Scan reduces need for invasive prostate biopsies

17 Mar 2026

A major trial co-led by St Vincent’s Hospital Sydney and Peter MacCallum Cancer Centre has shown a way to reduce the need for invasive biopsies to check for prostate cancer.

Patients with suspected prostate cancer usually have an MRI scan and, if the result is suspicious or inconclusive, they undergo a biopsy to collect prostate tissue for analysis.

This is a routine but invasive procedure that can be uncomfortable, worrying and is associated with side effects.

The PRIMARY2 trial recruited 660 Australians at higher risk of prostate cancer, due to their strong family history and other factors, and a low-risk or indeterminate MRI scan result.

These patients often go ahead with biopsy, and in the trial they were randomly assigned to either a standard biopsy or a PSMA PET/CT scan.

Professor Louise Emmett, Director of Theranostics and Nuclear Medicine at St Vincent's Hospital Sydney co-led the study with Professor Michael Hofman from Peter Mac.

“Getting told you have a risk of prostate cancer is a huge cause of anxiety and concern.

“Our findings show that PSMA PET/CT after MRI offers a 'belt and braces' approach that can determine which people have a clinically significant cancer, and which people are at low risk and don’t need a biopsy or further testing,” Professor Emmett said.

Dr James Buteau, a nuclear medicine physician at Peter Mac said: “PSMA PET/CT scanning makes prostate cancer cells light up in a remarkable way, particularly in more aggressive cancers,” 

“It’s rare to see such strong imaging that could be so powerful in the clinic.

“Incorporating this testing into clinical care could help to address the major challenge of prostate cancer overdiagnosis, which leads to at best unnecessary and at worst harmful treatment for cancers that would never cause any harm.”

The results of the PRIMARY2 trial were presented at the European Association of Urology Congress in London in mid-March.

The Phase III clinical trial showed PSMA PET/CT scanning could identify those who did not need a biopsy – as they either did not have cancer, or their cancer was so low-risk or slow-growing it would likely never cause harm.

Meanwhile, those with a positive PSMA PET/CT scan went on to have a biopsy, and this was guided by their PSMA PET/CT scan to collect tissue directly from suspicious areas.

Overall, this approach was seen to halve the number of people who needed a biopsy, without missing any harmful cancers.

A PSMA PET/CT scan involves injecting patients with a tracer that binds to prostate cancer cells and causes them to ‘glow’, appearing as bright spots in the scanning image.

The type of scan is increasingly accessible in the UK and Europe, primarily for diagnosing high-risk or recurrent prostate cancer, although cost and availability remain limitations to widespread use. It is widely available in Australia.

The PRIMARY2 study is also supported by the U.S. Prostate Cancer Foundation (PCF), St Vincent’s Hospital Curran Foundation, Peter MacCallum Cancer Foundation, National Health and Medical Research Council (NHRMC) and the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group.