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Radiology. #Prostate MRI… an alternative to biopsy?

Ultrasound guided biopsy of the prostate is the basis of prostate cancer diagnosis, but 60% of the time no cancer is detected.

 

There are numerous investigations aimed at better selecting the patients who ought to undergo prostate biopsy, therefore avoiding unnecessary biopsies.

 

Currently, early diagnosis of prostate cancer (PCa) depends largely on the result of the prostate specific antigen (PSA) blood test along with a digital rectal examination. Both tests are non-specific, so a positive result can trigger performance of a prostate biopsy to confirm diagnosis.

 

For example, PSA can be elevated in patients without prostate cancer, including in those who have a large prostate due to benign prostatic hyperplasia, older men with BPH, and those who have prostatitis or a urine infection.

 

Ultrasound guided prostate biopsy is the basis for diagnosis of PCa. But, of those patients who undergo biopsy due to digital rectal examination and/or a PSA suggestive of prostate cancer, 60% have no malignancy detected on histology. In other words, of every 100 patients who undergo prostate biopsy due to suspected PCa (suspicious digital rectal examination and/or raised PSA), only 40 have prostate cancer. The remaining 60 have undergone an invasive procedure, with possible adverse effects, but have a benign result.

 

The high percentage of initially negative biopsies, which are then repeated afterwards, involve considerable healthcare costs and impact negatively on patients’ quality of life due to the complications which can occur.

 

What does MRI contribute to prostate cancer diagnosis?

 

Magnetic Resonance Imaging (MRI) study of the prostate requires modern MRI equipment and a radiologist who is an expert in the technique. In men with suspected prostate cancer, the study is performed using 3 sequences: T2, axial diffusion and perfusion study.

 

● With 3T MRI it is possible to distinguish between cancerous tissue (especially when it is more aggressive) and normal prostate tissue. This can change the protocol for diagnosis of these tumours. It enables us to decide from where to take the biopsy. The traditional ultrasound-guided method, performed rectally, is imprecise and tumours are not visualised, therefore traditional biopsy does not detect many tumours.

 

● MRI is very reliable for patients who have already undergone prostate biopsy, if PSA continues to rise, a further biopsy may be considered. In these cases, MRI enables assessment of areas/foci which are suggestive of cancer, and to see whether the prostate is normal. If MRI identifies areas suggestive of cancer, targeted biopsy of the suspicious areas marked by the MRI is required. If the MRI is normal, and there are no suspicious areas, a biopsy can be avoided.

 

● Currently, MRI is also very useful in patients with elevated PSA and normal digital rectal examination, when a first biopsy is being considered due to the high PSA. In these cases, areas where cancer is suspected on MRI will indicate the need to perform a prostate biopsy. If the MRI is normal, without suspicious foci, biopsy can be avoided.

 

3 Tesla MRI offers higher precision in a shorter time.

 

The 3 Tesla MRI machine has a more powerful magnet, producing better images of the organs and soft tissue than other types of MRI.

 

The high-quality images obtained allow radiologists to precisely differentiate between benign and malignant lesions, with more certainty, leading to an earlier and more accurate diagnosis. The equipment improves the capacity to see smaller prostate tumours.

 

From the healthcare point of view, patient comfort is improved, as higher quality images are obtained in a shorter time, reducing patient waiting times. Within the area of molecular imaging, it provides new possibilities for early cancer diagnosis.

 

Whilst innovative diagnostic imaging is being implemented widely due to scientific endorsement, it is certainly still not available in all centres. At HC Marbella we already provide 3T MRI, ensuring an improved and faster diagnosis whilst improving patient experience.

 

Sources: Radiology.org / Instituto Nacional del Cancer (NIC) / Siemens Healthcare

 

 

April 29, 2019

 

 

 

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