mpMRI in the Diagnosis of Prostate Cancer
The diagnosis of prostate cancer is plagued by two issues. The first is the potential to ‘overdiagnose’ cancer, which means that small, low-grade cancers that may never cause problems are detected, and then potentially treated (also know as ‘overtreatment’). The second problem is that some more aggressive cancers may be missed with investigation. Unfortunately, these two problems are part and parcel of all tests in medicine.
The standard approach to diagnosis of prostate cancer has consisted of a PSA blood test and, if necessary, a prostate TRUS biopsy. These tests, when combined, can be effective but do lead to an element of ‘overdiagnosis’ & ‘overtreatment’ and occasionally more aggressive cancers can be missed.
There has been a lot of interest recently in the use of MRI to help with the diagnosis of prostate cancer. The hope has been that by using MRI (known as multiparametric MRI, or mpMRI) along with PSA tests (and possibly biopsy), the chance of overdiagnosis, or of missing aggressive cancers, can be reduced.
It is believed that the characteristics of aggressive prostate tumours may be unique on multiparametric MRI. By identifying the presence or absence of these MRI characteristics, biopsy may be targeted more accurately, or even avoided.
As well as identifying aggressive tumours, MRI may be useful for:
- Finding the location of tumours, and measuring tumour volume
- Staging of prostate cancer
- Helping to guide biopsy to increase accuracy
It is important to recognise that mpMRI is not perfect, and there is a good deal of debate about its exact role in the diagnosis of prostate cancer. It is certainly clear that it should be performed in experienced centres, and that the reporting needs to be standardised.
If you would like more information on mpMRI, please contact Nick Brook using the Web-form , or contact the Practice on 08 8267 1424.
As part of the work-up for your MRI, you will fill out a questionnaire in the radiology department. If any of the items below apply to you, please let the radiology department (eg. Bensons, Jones & Partners, Radiology SA, etc) know at the time of booking your MRI scan.
Tell the radiologist if you have ever had any of the following:
Artificial heart valve
Brain aneurysm clip
IVC (caval) filter
Intravascular coils (previous embolisation), filters, stents
Vascular clips or wires
Metal pins, plates, rods, screws, prosthesis
Implanted pain relief pump
Current intra-uterine device
Any other form of implant
A history of reaction to MRI contrast
A history of kidney disease
The radiologist also needs to know if you have any of the following
Skin patches (nicotine or pain relief)
A tattoo (including tattooed makeup)
Shrapnel or bullet wound
Dentures or braces
Any type of body piercing
Tell the Radiologist if you have you ever had:
Metal in your eyes
This list is not exhaustive, and is simply an indication of the questions you will be asked prior to your MRI. It is your responsibility to let the radiology company performing your MRI know about any of these issues.