Every patient is unique…
Shouldn’t their treatment for prostate cancer be unique as well?
Nearly 1 in 6 men will be diagnosed with prostate cancer which means this is the second cause of cancer-related deaths in men. Patients diagnosed with prostate cancer are often presented with multiple treatment options which vary enormously in risk and invasiveness. Valid options for most patients include: radical surgery, various types of radiation therapy, hormonal therapy, and even simply active surveillance. Treatment decisions are guided by how aggressive the tumor is on biopsy and the likelihood that the tumor has spread outside the prostate gland. This information is generated by inputting Gleason score, PSA, and age into tables of pooled data to get the chance that disease is confined to the gland. This is based on probability, not your individual case.
What Is A Multiparametric Prostate MRI?
Multiparametric MRI can change the equation. Now patients can get accurate information about their individual tumor to help them make the right decision about treatment. Our ultra-high resolution MRI imaging can demonstrate the extent of the tumor in the gland and demonstrate extension outside of the gland and also into the pelvis. Treatment decisions can be guided with the help of information about your specific lesion.
Our MRI protocol combines state of the art techniques. We utilize the endorectal coil on our 3T magnet to generate the most detailed and accurate images possible. These high resolution anatomic images are combined with functional information utilizing Diffusion Imaging and Dynamic Contrast Imaging to better localize the tumor and demonstrate tumor aggressiveness. Combined with this comprehensive Multiparametric MRI exam, it generates information that no other study can provide. We are also able to perform high resolution imaging without the endorectal coil for added patient comfort when needed.
Do I Need A Multiparametric Prostate MRI?
Prostate MRI can be particularly useful in the following cases:
- Patients with rising PSA level and a previous negative biopsy. MRI can identify patients at risk who should undergo repeat biopsy, and provide detailed information to increase the yield of the biopsy. MRI can also provide significant reassurance to patients and physicians when no lesion is seen.
- Staging of intermediate or high risk prostate cancer. MRI can distinguish between intracapsular and extracapsular disease and identify spread to lymph nodes and seminal vesicles. This can aid patients in making an informed decision regarding the best treatment option for their case.
- Prior to fusion biopsy. The next evolutionary step in prostate diagnosis uses the combination of MRI with 3D US to provide more accurate targeted biopsy of lesions identified by MRI. Fusion biopsy improves the accuracy of the prostate biopsy for clinically significant tumors. MRI may help to avoid unnecessary biopsy in some patients.
- In planning radiation treatment therapy for a patient. It is important for the radiation be targeted to the affected area. MRI can provide a clear picture to help the radiation oncologist guide the therapy that is most suited to a particular patient.
- Monitoring of patients on active surveillance. MRI can follow patients with lower risk prostate cancer for signs of disease progression, and identify which patients may need repeat biopsy or treatment.
What Happens During A Multiparametric Prostate MRI Exam?
MRI is an imaging technique that does not require exposure to non-ionizing radiation. Prior to the examination, all of our patients are offered an oral sedative. The Prostate MRI is most powerful when obtained with an endorectal coil placed into the rectum during the procedure. It is placed rectally because it provides maximal imaging quality (signal) and anatomic resolution when placed near the gland. An IV will be started to administer contrast to better enhance the blood flow to the prostate gland. Anatomic images are obtained of the prostate and entire pelvis to look at the bones and lymph nodes. Functional imaging is also performed with Diffusion Weighted sequences and Dynamic Perfusion Imaging during contrast injection. We are also able to perform high resolution prostate images without the endorectal coil when requested.
The exam includes several scans (sequences), some of which may last several minutes. The entire exam will be about 40 minutes. Our staff will explain the prep and procedure and make every effort to ensure the patient is comfortable through every step of the procedure.
After completion, our small panel of expert Sub-Specialty trained radiologists will review the images, issue a detailed report using the PIRADS-V2 system, and consult with the referring physician to formulate the best next-step approach.
How Does Multiparametric Prostate MRI Help Determine Staging?
Determining whether prostate cancer has spread beyond the capsule of the gland is key for staging and treatment planning. The difference in treatment options is dramatic. If the cancer is intracapsular, radiation therapy, surgery or active surveillance are viable options. However if the cancer has spread outside the gland, the tumor is T3 or T4 by definition and physicians might consider a more aggressive combination therapy.
Finding an appropriate diagnostic test to distinguish between intracapsular and extracapsular prostate cancer has been a challenge. DRE, PSA, Ultrasound, CT, and Bone Scans are all significantly limited for staging. High resolution Multiparametric MRI at 3T provides the most accurate staging information to guide therapeutic decisions.
MRI/US Fusion Biopsy: The Next Frontier of Prostate Diagnosis
Traditional random multiple core US guided prostate biopsy has been shown to have a false negative rate up to 47%. Also many patients are understaged due to undersampling of the most aggressive area of the tumor. Multiparametric MRI is highly accurate to identify high risk, aggressive tumors that require treatment.
We now have the capability to take the information obtained by MRI and using specialized 3D fusion software to fuse the MRI data to a real time 3D Ultrasound image. This allows the Urologist to perform a targeted biopsy of the suspicious area identified by MRI using Ultrasound. This targeted biopsy can be combined with additional random quadrant biopsies to improve overall diagnostic performance.
Studies have demonstrated that targeted biopsies identify 30% more high risk tumors, and may also reduce detection of low grade, low risk tumors that do not require treatment.
Why Choose BICRAD For Your Multiparametric Prostate MRI?
Providing leading medical care with state-of-the-art equipment is our top priority. Bay Imaging Consultants Medical Group consists of over 80 board certified and sub-specialized radiologists to service the community’s needs. Our registered technologists, and support staff are highly trained and strive to provide you with excellent service in our ACR certified facility. Prostate examinations are interpreted by a small panel of sub-specialty trained radiologists who have trained with the world wide experts in prostate imaging, and have years of clinical experience performing and interpreting these exams. We are dedicated to providing our patients state of the art care and diagnosis in a friendly, convenient and caring environment.
Advanced prostate cancer staging and treatment.
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Multiparametric prostate MRI helps determine the stage of your prostate cancer and plan effective treatment options. Take initiative during your journey and learn more about this helpful exam.