The American Cancer society estimates there will be 233,000 new cases of prostate cancer diagnosed in the US in 2014, more than any other site in men. In addition approximately 29,000 men will die from prostate cancer in the current year. This is fewer deaths than lung cancer, but more than colorectal cancer.
Currently most cases of prostate cancer are diagnosed by performing multiple random core biopsies of the prostate gland in men with abnormal values of PSA. However biopsy can miss significant lesions within the prostate gland and often detects many low grade tumors that are unlikely to lead to significant injury or death.
Prostate cancer treatment: Confusing choices
Once diagnosed with prostate cancer, patients are often presented with a bewildering array of treatment options, often without any clear information about which option would be most appropriate for their individual case. Choices often include surgery with removal of the prostate and lymph nodes, radiation therapy (with multiple different types of therapy available), medical treatment with anti-androgen medications, and active surveillance without other treatment.
Patients frequently make treatment choices based on information that comes from standardized tables (Partin nomogram) that look at prognosis and risk of spread based on PSA value and biopsy results. This is a useful tool, but can only estimate the chances that your cancer has spread outside the prostate gland. A test that can directly measure how much tumor is in the gland, determine its location, and show spread outside the gland can provide new information that is directly relevant to your individual case.
Prostate MRI: A game changer
Prostate MRI with endorectal coil has been available for over 30 years, however over the last several years there have been significant advances in prostate MR imaging that have revolutionized the field. Current state of the art centers can now perform multiparametric MR evaluation of the prostate. This test combines high resolution imaging of the prostate gland on a 3 Tesla magnet with the endorectal coil, with functional imaging of the prostate gland including diffusion and perfusion images. This combination allows highly trained expert radiologists to determine where tumor is located within the prostate gland, and if the tumor has spread outside the gland to local tissues, seminal vesicles or lymph nodes. Prostate MRI can help distinguish between slow growing tumors that are unlikely to spread, and more aggressive tumors that need aggressive treatment.
Once armed with information about their actual tumor from an MRI, patients are able to make more informed decisions about which treatment option is best for them. MRI can offer a much clearer assessment of your individual risk.
Other patients often encounter another difficult problem. They may have a very high PSA value, but the biopsy results came back negative. Unfortunately that does not always mean that they don’t have cancer, since biopsy can miss tumors up to 10%-38% of the time. MRI can also help in this instance. If the MRI is negative patients are reassured, but if the MRI shows a suspicious lesion, then targeted repeat biopsy is suggested.
Prostate MRI: Experience matters
Most MRI centers have little or no experience with prostate MRI. If you need an MRI of your prostate it is important to go to a center with the proper experience and expertise. At Magnetic Imaging Affiliates in Oakland we have been performing MRI of the prostate with the endorectal coil for 8 years, and for the last 4 years we have performed exclusively multiparametric imaging on our state of the art 3 Tesla magnet. Our technologists are highly experienced and have performed hundreds of exams. Our panel of 2 expert radiologists were trained by one of the top world wide prostate MRI experts and have over 30 years of combined experience with prostate MRI.