Do you still order mpMRI for staging of prostate cancer in addition to PET-PSMA?

Yes, I still think the prostate MRI adds valuable information for target delineation and local staging. This position is consistent with a recent poll of GU specialists where about 90% of respondents believed that a prostate MRI was still necessary after a PET/CT (Gillessen et al., PMID 35450732).

My...

1. Cancer Detection
   
   mpMRI has been incorporated into MRI-TRUS fusion-targeted biopsy protocols, which has led to an increase in the diagnosis of high-grade cancers with fewer biopsy cores, while reducing detection of low-grade and insignificant cancers.
   
   The PROMIS trial (Prospective Randomized Trial of ...

Staging: Yes, I still order mpMRI. The MRI should ideally be done before the biopsy to help guide that decision. If it was not done at that time, I use it to evaluate tumor location, multifocality, involvement of prostate capsule, seminal vesicle invasion, and involvement of the neurovascular bundle...

Great comments and agree with @Dr. First Last and @Dr. First Last.

To add one trial for reference about the benefit of combined targeted and systemic biopsy, the NIH Trio Study (Ahdoot et al., PMID 32130814) showed that prostatectomy upgraded pathology of 3.5% of those with combo vs 8.7% with target...

Yes, I do order the test as needed.