Could MRI give us the full picture on prostate cancer?

It’s not often that the release of a NICE guideline results in two headline stories in as many days. You will have probably heard on the radio, read in the paper or seen on television the initial discussion around active surveillance raised by the release of guidelines on diagnosing and treating prostate cancer. The NICE recommendation to consider active surveillance for low risk prostate cancer – a way of monitoring through regular check-ups rather than treating it straight away – is good news. For many men this could be a successful avenue that avoids the unpleasant side-effects such as erectile dysfunction and incontinence, which are risks associated with invasive forms of treatment such as surgery.

For me, the most exciting news the guideline contained – and which has made the headlines today – is the recommendation to use MRI as a diagnostic tool. NICE recommend the use of multiparametric MRI – a particularly accurate method of imaging – after one negative prostate biopsy. If you’ve had a prostate biopsy, you’ll know the last thing you want is another one, but multiple biopsies are not uncommon.

A prostate biopsy is not the first port of call when checking for prostate cancer; to get this far along the diagnostic pathway – a minefield for both men and clinicians – a man will have had his PSA level checked (a simple blood test) and found it to be higher than normal.

A biopsy of the prostate generally involves inserting a needle into the gland (guided by ultrasound through a probe inserted up your bottom) and taking 10 to 12 tissue samples. It can be a deeply unpleasant process and one that comes with risks of infection. And here’s the rub: one negative biopsy result doesn’t necessarily mean the prostate is wholly cancer free. Taking 10 to12 very small tissue samples from a gland the size of a walnut cannot always give a fully accurate picture. If a man’s presentation and previous tests suggests he has prostate cancer, but his initial biopsy is negative, he may face further invasive biopsies to ensure his doctors get the diagnosis correct. And let’s be clear: once you’ve heard that prostate cancer may be on the cards, you want to be damn sure if you’ve got it or not.

Introducing multiparametric MRI into this diagnostic pathway after the first negative biopsy will allow doctors to get an accurate image of the whole of the prostate in one go. This imaging will then either confirm that the gland is free from cancer, or help confirm the location of the tumour for subsequent biopsies and speed up the whole process. This is great news for men.

This imaging is such a useful and accurate diagnostic tool, it begs the question why not do it before taking a prostate biopsy? This question is being rigorously tested in clinical trials right now, and the results are due very soon. Hopefully missing the deadline for this guideline won’t result in a hold up in pre-biopsy MRI entering clinical practice if it indeed proves beneficial to men.

3 thoughts on “Could MRI give us the full picture on prostate cancer?

  1. I think this is positive news.. Im 42 and recently been diagnosed with prostate cancer. I had been for 4 blood tests 1 from GP (high PSA result, referred and 3 follow up assessment bloods from the hospital. (I initially requested 1st test from my GP at 41 due to father having prostate cancer)
    At my meeting to discuss the next step after blood tests showed high psa I asked if I could have the MRI first before having the invasive biopsy and was told that the biopsy would be done 1st. my results from the biopsy confirmed cancer but I now have a 10 week wait for my MRI due to scarring/bleeding from the biopsy routine.
    With all this in mind I feel that more men would face treatment or pre-emptive checks if they knew an mri could be used 1st. and personally I wouldn’t have to wait so long if my assessment had been done differently as Id initially requested. Im not having ago at any one it’s just that the rules changed to late for me on this one. just got to get my head around the rest of it all now..

  2. I do sympathise with you. I am no expert, but having had an increasing PSA level for several months and subsequently being advised that a biopsy is the next step, I have been reading up about Prof Mark Emberton ( london) and his fellow consultants / surgeons, and the more powerful 3T scanners, which can help detect cancer to see if a biopsy is required. If so, I understand it helps the uroligist to then direct the needles into the right area during the biopsy. There are some fantastic advances been made, but at present, the updated diagnosis pathway and treatment are not being offered across the UK. I am hoping to be referred to London for a MRI first…..then if necessary….have a biopsy….but of course, this takes time.

    Take a look at the following link and watch the videos… is really interesting and thought provoking….. it seems that diagnosis and treatment re prostrate cancer avaiable to the masses has remained the same for 20 years – it’s time to move forward!

  3. Husband 58. PSA7, test advised by a pro active nurse practioner.
    Follow up 1 biopsy, 8 samples 7 negative, 1 positve (gleason 3+4) predictive med grade cancer.
    Treatment options Watch and wait / Radiotherapy / Radical removal (very enlarged gland). Husband went for removal, thank goodness as histology results upgraded the cancer to high grade and widespread (dispite 7 negative samples). Where would we be now if he had choosen watch and wait?
    Anything that shortens the intial investigations to decision time must be good, To be able to direct the biopsy to an area of concern as apposed to a hit and miss test must be a no-brainer. I’m with Ian ‘it’s time to move forward’!
    Lets hope the information is out there and G Ps are up to speed.

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