Multiparametric magnetic resonance imaging (mpMRI) for Prostate Cancer
Multiparametric magnetic resonance imaging (mpMRI) currently is the most promising, non-invasive technique imaging test that may be able to locate potentially deadly cancer while avoiding, low grade, harmless prostate cancer, thus preventing unnecessary treatment. “Multi-parametric” means the performance of three scans sequentially during a single visit to the imaging center:
The three scans are:
1. T3-weighted imaging. This allows for the best assessment of the prostate morphology, size, margins, and internal structures with easy differentiation between the prostate’s various sections.
2. Diffusion-weighted imaging. This details the tissue microstructure and generates an “apparent diffusion coefficient” (ADC), which helps to determine the aggressiveness of a lesion if one is seen.
3. Dynamic contrast-enhanced imaging. This detects areas of increased vascularity to better detail any suspect lesions.
A radiologist reads the information from the three scans and compiles a report. Findings are then summarized in an “overall impression,” which falls into one of five categories:
1=clinically significant disease is highly unlikely to be present
2=clinically significant disease is unlikely to be present
3=clinically significant disease is equivocal
4=clinically significant disease is likely to be present
5=clinically significant disease is highly likely
For men treated with radiation, mpMRI can detect recurrence of prostate cancer with reasonable sensitivity compared with a biopsy.
The only way to accurately determine if you may have prostate cancer is with a biopsy. There’s no way around that.
Biopsies can be done in the doctor’s office in about 15 minutes. There are two types: random and targeted.
Random Prostate Biopsy
Random biopsies is the most popular and are performed with a process called a transrectal ultrasound (TRUS) guided biopsy. You physician inserts a probe in the rectum while identifying the prostate area of interest on a monitor. Then a thin needle is shot through the rectal tissue in a fraction of a second to take small random samples of prostate tissue, called a core. The number of cores can vary, but the average is around 12.
Many problems exist with random prostate biopsies, such as:
• Aggressive cancers are often missed
• Harmless tumors are often found
• Excess biopsies are performed when PSA continues to rise
• Higher than usual amount of samples are taken (more than 20), which increases the risk of infection and erectile dysfunction.
I predict that random biopsies will be completely replaced by target biopsies within the next five to 10 years.
Targeted Prostate Biopsy
Target prostate biopsy blend ultrasound images along with MRI images (also known as fusion biopsy) in order to target specific prostate tissue that appears suspicious does targeted biopsies. This method has proven to be more specific and targeting the bad cancer that may show to be dangerous.
There will still be discomfort
Either prostate biopsy will cause some discomfort, but not serious pain. Your doctor will prescribe an antibiotic to take one day before and a few days after the procedure to avoid infection. You may experience a little soreness for about afterward, and you may notice blood in your urine or semen for a few weeks.
Want to know if prostate cancer exists without a biopsy?
Many patients ask me if it’s possible to determine if they have prostate cancer without a biopsy. While it is true MRI images continuously improve, and other biomarkers like PCA 3 help with diagnosing prostate cancer, a biopsy is still the only way any physician can make a diagnosis of prostate cancer.
Yes, I know, that’s not what you want to hear, but a prostate biopsy is the gold standard for diagnosis, and no physician will be able to make a conclusive diagnosis without it.
This video provides a comprehensive, easy-to-understand and latest approach on screening for prostate cancer.
Currently, NYU department of Urology is one of the leading urology clinics in the United States with mpMRI, fusion biopsy and comprehensive, holistic approaches to prostate cancer. A list of MRI facilities are found HERE by the Prostate Cancer Research Institute.