PROSTATE IMAGING: new horizon in early prostate cancer detection and treatment

Screening for Prostate Cancer Using MRI…“Multi-parametric” testing using a 3T scanner MRI

A new clinical study will test for the first time if MRI scans can be used for population screening to detect prostate cancer more accurately.

In American men, prostate cancer is only behind skin cancer as the most common form of cancer. Statistics showed in the U.S. there were about 164,690 new diagnoses of prostate cancer and about 29,430 death from prostate cancer in 2018. In their lifetime 1-9 men will be diagnosed with prostate cancer, and 1 in 41 of those diagnosed will succumb to complications related to the disease. The five-year survival rate for prostate cancer patients falls to 29% when prostate cancer metastasizes and spreads through the body. This staggering decline in survival rate highlights the serious disadvantages the NCCN recommended treatments have when trying to treat prostate cancer that has spread, become treatment-resistant, and recurrent.

The current prostate-specific antigen (PSA) test is considered too unreliable for population screening, but MRI could be used to screen men to pick up cancers earlier and more reliably, potentially helping to save lives. MRI is the most commonly used technique to take images of the prostate gland. It does not use ionizing radiation, and it provides images that are clearer and more detailed than other imaging methods. Ultrasound is generally used when a prostate biopsy is required.

Recent advances in MRI , including Mp-MRI (“Multi-parametric” testing using a 3T scanner)imaging have changed everything. The latest generation of MRI machines called 3 Tesla, or 3T machines, scan at a much higher resolution than the earlier machines. They enable radiologists to see all but the tiniest tumors. The tumors that they can’t see almost certainly don’t matter.

Prostate cancer is the second-leading cause of cancer death in men after lung cancer

Mp-MRI of the prostate uses different parameters to characterize cancer, thus the term “multiparametric MRI” or “mpMRI.” Standard tissue contrast images are generated on T1 and T2-weighted imaging. These images cannot discriminate cancer from benign changes, but have the highest spatial resolution and are the best for delineating the prostate capsule. Therefore, they are used to determine if prostate cancer is confined to the prostate or not. Diffusion-weighted imaging (DWI), along with the accompanying apparent diffusion coefficient (ADC) map, measure Brownian free water motion, and therefore the degree of cellular density , constrained and disorder. This has been shown to be the best measure of the aggressiveness of prostate cancer, but it is much lower in resolution compared with T2-weighted imaging. Although it correlates well with grade of cancer, it is not as accurate to estimate the stage of cancer compared to T2-weighted imaging. Blood flow is disordered in most tumors and some other conditions. Dynamic contrast enhanced (DCE) perfusion imaging uses continuously acquired images of the prostate during intravenous injection of a contrast dye containing gadolinium—a rare earth element—to map blood flow. Although it is not as accurate as T2-weighted images or DWI in the detection of significant cancer, it is a valuable adjunct in problem cases, and is invaluable for characterizing the prostate after therapy (including hormonal and radiation treatment). Spectroscopic imaging can measure the concentrations of specific chemicals in the category of “metabolites” and can be especially useful in problem cases. However, the procedure takes the longest, requires the use of an endorectal coil (a small probe in the rectum), and may result in additional costs

“MRI scanning for prostate cancer could also help a quarter of a million men, maybe up to half a million men a year, to avoid an unnecessary biopsy if the MRI is negative. The majority of men will be reassured they don’t have prostate cancer and importantly they may be able to avoid the harms of a biopsy, plus healthcare systems will be able to avoid the costs. MRI is the perfect tool because it’s relatively cheap, widely available and reliable.”said  Professor Mark, Emberton at University College London.

The MRI report will provide two types of important information:

The MRI measures the size of the prostate. The scan report will enable you to determine if your PSA elevation is proportionate to your prostate size.  As regards cancer,  there are three possible outcomes:

No high grade cancer. Further monitoring without biopsy is OK.
A high-grade lesion is detected.  Targeted biopsy is needed.
An ambiguous area is detected.  Another MRI in 6 months may be appropriate.

 

Scanning the prostate in men with PSA elevation is a brand new approach that is more reliable than the old-fashioned method of using 12 random needle sticks. However, this claim is only accurate when using the very latest state-of-the-art MRI technology at approved centers. This technology is so new that finding doctors willing to abandon the old random needle biopsy approach is still a major challenge.  Even so, there is a big payoff, being able to bypass those needles, those infections, and the inaccuracy is worth it.

What are some common uses of the examination?

The primary reason for a patient to be referred for an MRI of the prostate is to evaluate the potential presence of prostate cancer. The test is commonly used to assess for the presence of the condition and evaluate the extent in order to determine if the cancer is confined to the prostate, or if it has spread outside of the prostate gland.

Occasionally, MRI of the prostate is used to evaluate other prostate problems, including:

  • infection (prostatitis) or prostate abscess
  • an enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH)
  • congenital abnormalities
  • complications after pelvic surgery.

Who interprets the results and how do I receive them?

A Consultant Radiologist, a Doctor specifically trained to interpret radiology examinations, will analyse the images and send a report to your referring Doctor

Call us for more information about Prostate MRI  or to find locations that provide MRI ’s in Hudson County or  West New York, NJ. You can also contact advanced Magnetic Imaging at 201-295-1099 for information about low-cost MRI and other cancer screenings in NJ,

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