Dr Christopher Kane Explains How MRI Is Influencing Prostate Cancer Diagnosis

Magnetic resonance imaging (MRI) really makes a difference when studying men who’ve had a negative prostate biopsy, but their prostate-specific antigen goes up overtime or something changes and we think there’s a continuing concern for prostate cancer, said Christopher Kane, MD, professor of urology, University of California, San Diego.

Transcript (slightly modified)

How is MRI influencing prostate cancer diagnosis?

I think magnetic resonance imaging (MRI) has been 1 of the big changes over the last 5 years. The first place that MRI really makes a difference is in studying men who’ve had previous prostate biopsy, and that biopsy was negative, and overtime their prostate-specific antigen (PSA) goes up or something changes and we think there’s a continuing concern for prostate cancer. Now, we routinely do an MRI before we do a repeat biopsy, and if we see regions that are suspicious for high-grade prostate cancer, we adjust the biopsy to make sure we hit those regions, and that’s called targeted biopsy. That very much improves the outcome of repeat prostate biopsy.

So, we’ve known that and it’s been in our guidelines for more than 5 years, and what’s technology, and now we’re wondering, “Gee, if I have a man and we’re going to recommend a prostate biopsy based on PSA or family history or rectal exam, shouldn’t we do an MRI prior to similarly improve the performance of our biopsy?”

I think many of our programs that are using MRI more liberally are wondering whether we can improve the performance of the initial prostate biopsy by doing an MRI, and that’s an area of controversy not yet in the guidelines. The big controversy is that if we do this is that we’re going to increase costs of the screening episode, and is that justified by the marginal improvement in diagnostics.

That’s the subject of a number of clinical trials. It was the subject of the session this morning. A debate between Professor Emberton and Dr Pedrosa about where is MRI moving, and I think 1 of the places it’s likely moving is earlier, meaning for the initial prostate biopsy.