Prebiopsy Prostate MRI Use Rising in US Veterans but Key Gaps Persist

Key Clinical Summary

• Prebiopsy prostate magnetic resonance imaging (MRI) use in the US Veterans Health Administration (VHA) rose from 2% in 2015 to 41% in 2023, surpassing SEER-Medicare benchmarks.
• Black and rural veterans remained significantly less likely to receive MRI despite higher prostate-specific antigen (PSA) levels or younger age.
• Marked variation persisted across VHA sites: 42% of facilities used MRI in < 5% of cases.

A national VHA analysis evaluated trends and disparities in prebiopsy MRI use from 2015 to 2023. The findings provide important insight for clinicians caring for US military veterans with elevated PSA levels.

Study Findings

Across 120 105 biopsy-naive veterans with elevated PSA levels, prebiopsy prostate MRI utilization increased sharply, from 2% (121/7199) in 2015 to 41% (5885/14 244) in 2023. Despite this progress, disparities were evident.

Black veterans, representing 30% of the cohort, had lower MRI utilization than non-Black veterans in 2023 (37% vs 44%; −7% absolute difference; P < .001). This occurred although Black patients were younger (median 68 vs 72 years; P < .001) and had higher PSA levels (> 10 ng/mL in 14% vs 11%; P < .001). Rural veterans similarly experienced reduced access, with utilization of 35% vs 43% among nonrural peers (P < .001).

MRI use also varied widely across the VHA’s 132 sites. Notably, 42% of facilities had MRI utilization below 5%, reflecting heterogeneous practice patterns despite a unified national system. Multivariable mixed-effects models confirmed persistently lower odds of receiving MRI among Black patients (OR, 0.83; 95% CI, 0.75-0.91) and rural veterans (OR, 0.73; 95% CI, 0.67-0.81) in 2023.

The VHA overall outperformed SEER-Medicare’s 30% benchmark but remained well below MRI utilization rates at some academic centers, where use now approaches 90%.

Clinical Implications

For clinicians caring for US veterans, these findings highlight an urgent need to improve equitable access to prostate MRI. Lower MRI utilization among Black and rural veterans is concerning because these populations face higher prostate cancer incidence and mortality.

Veterans receiving care at low-utilization sites may be more likely to undergo unnecessary biopsies or experience delayed detection of clinically significant disease. For high-risk groups, reduced MRI access could compound existing disparities in stage at diagnosis and outcomes. Identifying barriers—such as MRI availability, scheduling capacity, geographic distance, or clinician referral patterns—will be key to ensuring uniform care delivery across the VHA.

The study’s authors emphasized that the observed gaps persist despite an integrated, equal-access health system. They noted, “Our findings suggest a need to improve access to prostate MRI nationally and expand capacity within the VHA,” underscoring that disparities similar to those seen in Medicare remain present within the veteran population.

Conclusion

Prebiopsy prostate MRI use is rising rapidly across the VHA but remains uneven, particularly for Black and rural veterans. Addressing capacity and access barriers will be essential to ensuring equitable prostate cancer diagnosis and improving outcomes for all US veterans.

Reference

Huang MM, Nicolas JD, Alam R, et al. MRI utilization rates for veterans at risk of prostate cancer. JAMA Netw Open. 2025;8(11):e2543567. doi:10.1001/jamanetworkopen.2025.43567