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A Less Invasive Test for Prostate Screenings

Posted by Randall A. Stenoien MD, ABR on Jun 11, 2019 11:03:00 AM

Written by Dr. Randall Stenoien and KHOU 11

Prostate cancer is the third most common type of cancer, coming in behind breast cancer and lung cancer. The National Cancer Institute's Surveillance, Epidemiology, and End Results Program anticipates approximately 165,000 new cases will be diagnosed in 2018.

Dr Stenoien

While the 5-year survival rate for prostate cancer is quite high at 98.2 percent, possible complications including difficulty urinating, pelvic area discomfort, erectile dysfunction, and painful bone metastases make it a serious health issue for some.

Prostate Screening Recommendations

According to the American Cancer Society, most men should begin talking with their doctors about prostate screenings at age 50 — earlier if there is an increased risk of prostate cancer. Prostate screening can include having a prostate-specific antigen (PSA) test done, via a blood test, or a digital rectal exam. Abnormal PSA levels can indicate the possibility of prostate cancer but could also be caused by benign enlargement or inflammation of the prostate.

The History of MRI Usage for Prostate Issues

Some patients will be offered the option of a prostate MRI (magnetic resonance imaging), which until recently was performed on a 1.5 Tesla (1.5T) device using an endorectal probe. One issue that comes up, however, is that many men are hesitant — or absolutely refuse — to undergo an examination with an endorectal probe.

For some, this is because of the possible discomfort, which can include pain and rectal bleeding, while others just aren't comfortable with the procedure itself. This is where ultra-high field (3T) MRI can be of benefit.

MRI of the prostate is not considered a screening test. Rather, physicians use this exam to problem solve. This most often pertains to a patient with an abnormal digital prostate exam or rising PSA who has previously had a negative biopsy.

In patients with a positive biopsy, an MRI more accurately stages the cancer (identifies extension outside of the prostate) or may identifies a more aggressive lesion than was diagnosed at the time of biopsy. Finally, there is a significant group of patients who have very low grade (Gleason score 3+3) prostate cancers who opt for no treatment but desire surveillance to exclude local disease progression.

Benefits of Using High-Field 3T MRI for the Prostate

The New England Journal of Medicine study found that the use of high-field 3T MRI without an endorectal coil was an excellent test in both terms of sensitivity and specificity. Researchers found that the use of the MRI prior to biopsy led to increased diagnoses of aggressive (clinically significant) cancers, as well as a decrease in the number of diagnoses of low-grade cancers (those that do not require immediate treatment and can just be monitored). This was judged cost-effective and thus raises the possibility of performing the prostate MRI prior to transrectal ultrasound guided prostate biopsy, currently considered the gold standard in prostate cancer diagnosis.

Prostate MRI at Houston Medical Imaging

When it comes to 3T MRI of the prostate, Houston Medical Imaging performs more prostate exams than any other freestanding imaging center in the Houston metropolitan area. Combining state-of-the-art 3T imaging and DynaCAD technology, Dr. Randall Stenoien and Dr. Adel Salehi have extensive experience with prostate MRI imaging. They, not technologists, personally process each exam on the DynaCAD workstation.

They work with the urologists to assist them with patient management, including providing a 3D model of the prostate and targeting any suspicious lesion in order that a precise fusion biopsy of the prostate (performed by the urologist in their facility) can more accurately diagnose prostate cancer. Once the test is complete and the results in, you'll be able to talk to your urologist about the exams and help create a plan for your health care needs moving forward.

While several hospital facilities can also perform this procedure, the cost is likely to be significantly higher than having the exam done at an independent medical imaging center like HMI. Quality imaging, radiologist expertise, independent workstation processing, and efficient communication with your doctor are equally important considerations in your final decision on whom to choose for your imaging exam.

Next Steps

It's important to be an active participant in your medical care and work with your health care team. If you feel like a prostate MRI may be something you're interested in as a screening tool or as part of a larger prostate cancer evaluation plan, discussing this option with your doctor is the first step.

For more information or options for scheduling an MRI please call Houston Medical Imaging at: 713-589-5231 or visit our website. To see a video of Dr. Stenoien explain how to prep for an MRI of the prostate, please click here.

 Radiologists Dr. Stenoien and Dr. Salehi

Sources:

https://www.cancer.org/cancer/prostate-can- cer/early-dettion/acs-recommendations.html https://seer.cancer.gov/stafacts/hml/prost.html https://www.mayoclinic.org/diseases-condi- tions/prostate-cancer/symptoms-causes/syc -20353087 https://www.cancer.gov/types/prostate/p- sa-fact-sheet