WSJ: Should MRI to Detect Prostate Cancer Become Standard of Care?

A growing body of evidence proves MRI can effectively identify suspicious lesions prior to biopsy. MRI generally does not detect indolent tumors that do not require treatment and can guide biopsy needles for more precise targeting. This reduces the necessity for repeat biopsies while increasing detection rates for high-risk, high-grade prostate cancers. However, the practice of using MRI to detect prostate cancer before performing biopsy is not widespread. In a recent article, the Wall Street Journal asks, should it be?

Applications for MRI in Prostate Cancer Detection and Treatment Planning

Numerous data have now been produced to show that MRI can help physicians detect a larger percentage of high-grade, aggressive cancers than conventional biopsies. The current standard of care starts with a prostate-specific antigen (PSA) test and progresses to biopsy if PSA levels are determined to be high. However, conventional prostate biopsy performed with ultrasound cannot adequately target suspicious nodules.

This process leads to numerous repeat biopsies until cancer is detected or until a patient decides to end screening. One recent study, published July 2014 in European Urology, demonstrated how the use of MRI to detect prostate cancer can help to triage patients with suspicious findings for targeted biopsy.

• Reduce the number of biopsies by 36 percent.
• Reduce number of cores taken by 84 percent.
• Reduce detection of low-risk cancer by 87 percent.
• Increase detection of intermediate- and high-risk cancer by 18 percent.

The reduction in detection of low-risk cancers compared with the increase in detection of intermediate- and high-risk cancers is significant because the current standard of care has often resulted in inappropriate prostate cancer management strategy. As reporter Sumathi Reddy notes in the Nov. 3, 2014 article:

Because conventional biopsies can’t always distinguish when a cancer is clinically insignificant, patients sometimes undergo unnecessary surgery, radiation or other therapy. Such overtreatment has been a concern in the medical community for some time.

Controversy over MRI as Standard of Care in Prostate Cancer Screening

Despite obvious benefits to the use of MRI in prostate cancer detection, there is some controversy surrounding the technique. Detractors note that there is not a vast number of radiologists experienced in the interpretation of prostate MRI exams, according to Reddy. While it is important to note that experience matters, radiologists experienced with MRI in prostate cancer detection can offer greater clarity regarding rising PSA levels, prostate cancer diagnoses and prostate cancer prognoses.

“Improved imaging with MRI may allow one to confidently recommend surveillance to a greater number of patients and to discover aggressive disease in areas that are not usually biopsied,” said Center for Cancer Research at the National Cancer Institute Clinical Director William Dahut, M.D. “No technology is perfect, that’s for sure. However, it is clear that our tools and ability to use these tools continues to markedly improve.”

We believe prostate MRI is an increasingly valuable tool in prostate cancer detection and that it offers patients more accurate information about their disease to inform treatment decisions. As ongoing research unveils new potential for MRI in prostate cancer detection, it may ultimately prove to be the long-sought alternative to the current standard of care.

Our dedicated prostate imaging specialists have now read more than 4,000 combined prostate MRI exams. We now offer prostate imaging on 3T MRI at 7 locations in California and are expanding services to improve patient access in the immediate future.

To learn more about our prostate imaging services, please call 805-778-1513 or use our online ‘Contact Us’ form.