MRI for Prostate Cancer Screening Could Spare You a Biopsy

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Up until now, the usual screening process for prostate cancer has involved an uncomfortable amount of guesswork. It started with a PSA test (which is already controversial), and then, if your PSA was high, doctors would perform a biopsy—meaning they would insert a biopsy gun into your rectum and take tissue samples from your prostate.

Not only is this procedure painful and unpleasant, but it’s pretty inaccurate. Plus, it often comes with bleeding and infection.

Today I have good news. A new study published in the Lancet looked at a new way to screen for prostate cancer. It’s accurate, painless, and doesn’t involve anyone sticking anything up you know where. In fact, for some men, it could circumvent a biopsy altogether. The only issue I have noticed is with men who have fear or anxiety from being in confined places (claustrophobia).  

The Study Details

    • From 2012 to 2015, researchers screened 576 men for prostate cancer by giving them a 1.5 Tesla MP MRI as well as two biopsies. (The 1.5 Tesla MP MRI is a new, non-invasive screening method.)
    • Of those 576 men, it turned out that 71% of them had cancer. Two in five had clinically significant cancer—which meant a Gleason score higher than 4+3.
  • The MP-MRI was much more sensitive and accurate than biopsy for detecting cancer, and it was able to scan the whole prostate (instead of just a few spots).
    • Several of the biopsies resulted in negative side-effects, including 8 cases of sepsis.
  • The researchers estimate that the MP-MRI could spare 27% of men the pain of a biopsy, because it would let them know with greater certainty whether their cancer was risky.

 

My take on the MP-MRI

As a naturopathic urologist, I want to give my patients the treatment that will have the least negative side effects. Up until now, I sometimes had to bite the bullet and send patients off for a biopsy to confirm whether or not they had significant cancer. The problem with biopsy is that it’s relatively inaccurate and comes with negative side effects.

I mean, they’re sticking a needle up your behind.

The idea that 1 in 4 men may be able to forgo this unpleasant treatment is a breath of fresh air to me.

The best sequence for prostate cancer screening is the following:

  1. PSA test – while there is still controversy on the PSA test, the fact remains that a high value (>10) usually indicates, though not always, that cancer cells may be present. Also, PSA with high velocity or a rapid increase within time may also be suggestive of cancer cells. But again, this is not always the case.
  2. Digital Rectal Exam (DRE) – if any part of your prostate feels like one of your knuckles, it may be a cancerous tumor. Sometimes it’s not cancer, though; it might be calcification.
  3. 4K Score or Prostate Health Index (Phi) – these are blood tests that can be more suggestive of cancer and confirm if there is concern from the PSA or DRE.
  4. Tesla MP-MRI – is a new, state-of-the-art technology that can best detect potentially deadly tumors.
  5. Fusion Targeted Biopsy – blends the images of the MP-MRI with a more sophisticated ultrasound, the Artemis. Then the physician can best target the areas that are most suspicious. This approach is much more accurate than the random ultrasound-guided biopsy that has many false negatives.

One problem — Health Insurance

In the US, health insurance companies are not paying for prostate related MRI.

In my office, we noticed that our patients have been denied coverage of MRI for prostate cancer screening. It’s actually a huge pain in the rear. Our billing personnel have to spend hours on the phone with health insurance reps to get MRI approved without confirmed diagnosis of prostate cancer, a PSA higher than 11ng/ml, or a positive DRE. However, patients with a confirmed biopsy and on Active Surveillance can get their MRI cost covered.

Patients without a diagnosis, positive DRE or very high PSA have a tougher time. The patient can appeal and sometimes they get it covered. But it does come with a time consuming “fight” between your doctor’s office, you and the health insurance company.

The bottom line

This most recent European study shows the pre-biopsy MRI can save 27% of men from getting a biopsy. This can then lead to further health care savings and unwanted biopsies. When you talk to your physician ask her for a 3 Tesla Multi-Parametric MRI (that’s what is called).  Know that in the US you may have an issue getting it covered by your health plan. Hassle them enough and they may cover it.  It runs about $3000.00. 

Be well.

 

Previous Blog Posts

Testosterone Connection to Prostate Cancer

Long Harvard study on what makes men happy and healthy

Man who refused prostate cancer treatment 27 years ago and opted for lifestyle change

Related Blog Posts

Targeted Biopsy for Prostate Cancer

My Prostate Cancer Book

Thrive Don’t Only Survive

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by Dr. Geo

5 comments… add one
  • joe ,

    DR. Geo,

    Wow, great articles this month. I am tweeting and posting on linked in. I tell every guy in shouting range about MRI of the prostate. This article supports my soapbox messages.

    It would be great if the pissing contest (pun intended) between urologist & Insurance Companies vs. Interventional Radiologist would reach common ground. It’s about the patient…stupid’s.

    Even if insurance will cover the imaging they will not pay 100% to go to the most experienced at performing and READING MRI’s. If it is a low quality image coupled with an inexperienced reader you might as well stay with the TRUS up your bum. Insurance will actually pay for inferior quality…what’s the point?

    If you are thinking of getting an MRI…do the research. There are a handful of pioneers who have the best technology & have the experience/expertise in performing and READING (I cannot stress this point enough) the MRI of the prostate.

    Go hug your prostate today…er…that’s awkward. You know what I mean.

    Reply
  • Bill Moore ,

    It is irritating that insurance companies can deny the MRI. It is less invasive and the biopsy is barbaric in my opinion. This is the kind of changes that need to be made to the health care industry is not allowing the ins industry to have as much power on denials.

    Reply
  • Hey there Geo, great job!

    This Lancet article nicely demonstrates the benefit of prostate MRI. But please be very careful promoting it as the end-all diagnostic study. There are several prior publications with large cohorts of patients showing the negative predictive value of prostate MRI is somewhere around 80 to 85%.

    I love prostate MRI and I actually order it on every single patient with an elevated PSA – even with no prior biopsy. (This is certainly not the standard, although I think it should be…) Cost is certainly a counter argument.

    But a man with a negative MRI and no prior biopsy really still needs at least one biopsy. I have a number of patients who have had a completely clean prostate MRI (high quality, 3T, great radiologist, reread by me, etc.) and were found to have clinically significant cancer on standard TRUS biopsy – a 43-yr old just last month!

    Cheers!

    Reply
    • Point well taken. When a good study comes out we are always at risk of oversimplification. In the article on the blog I gave the best method(in my opinion) for prostate cancer screening.

      Reply
  • Donald Jones ,

    Thank you for this info.
    Have finished my Radiation and Seed implants, waiting for healing for results.
    Will give info to mu Urologist and Radiologist.
    Not looking forward to another Biopsy for any reason.

    Reply

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