Magnetic Resonance Imaging (MRI) Instead of a Prostate Biopsy

For several decades I have ordered PSA testing as a screening test for prostate cancer, the most common cancer in middle aged men and the second most cause of death, following lung cancer, in men.  The PSA test is now controversial as a result of the U.S. Preventive Services Task Force recommended five years ago that men forgo the test because the blood test led to too many inaccurate prostate biopsies, which in turn resulted in diagnosis  of insignificant prostate cancer or cancers that were so slow growing that no treatment was required and also resulted in many men who received treatment and had side effects and complications that significantly impaired their quality of life.

Now, however, there is true progress in prostate cancer detection, bringing a new era of minimal intervention yet maximum accuracy of diagnosis and treatment. The single most important factor in this change is the addition of multiparametric MRI (mpMRI) before having a prostate biopsy. There is compelling research-based evidence, both in the U.S. and abroad, that mpMRI can help determine if a biopsy is not yet necessary. This means sparing men from conventional TRUS-guided biopsy that has a discouraging track record of inaccuracy. On the other hand, if mpMRI detects a suspicious area, a real-time MRI guided targeted biopsy facilitates pinpoint diagnosis and treatment matching.

According to a newly published article, “Prebiopsy MRI followed by targeted biopsy” appears to have the ability to overcome the limitations of the standard 12-core template [biopsy]. The authors of the review point out that both the American Urological Association and the Society of Abdominal Radiology have confirmed the utilization of MRI prior to biopsy.

I hope you have found this blog helpful.  If you have any questions about managing your elevated PSA, please let me hear from you.

Tags: MRI of prostate, prostate biopsy, PSA, PSA testing