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In medicine, change sometimes happens with two steps forward but one step back. For example, in the early 20th century, delivering babies in hospitals became more popular than home births in order to have “painless” births with anesthesia. However, for many women the higher complication and infection rates proved to be a setback. Thankfully, problems were eventually corrected and improvements made. Now most pregnant women choose a hospital or birthing center over a home birth.
Related: Using MRI To Detect Prostate Cancer
In men’s health, specifically prostate cancer (PCa), what was once hailed as a life-saving breakthrough – the PSA blood test – has come under fire. Despite saving tens of thousands of lives through early detection, within the past 5 years the U.S. Preventive Services Task Force began to see the test as a step backward; the blood test led to too many inaccurate TRUS biopsies, which in turn resulted in overdetection of insignificant PCa and underdetection of significant disease. Ultimately, countless men underwent overtreatment and ended up with impaired quality of life.
Now, however, there is true progress in PCa detection, bringing a new era of minimal intervention yet maximum accuracy of diagnosis and treatment.
The single most important factor in this change is the addition of multiparametric MRI (mpMRI) before having a prostate biopsy. There is compelling research-based evidence, both in the U.S. and abroad, that mpMRI can help determine if a biopsy is not yet necessary. This means sparing men from conventional TRUS-guided biopsy that has a discouraging track record of inaccuracy. On the other hand, if mpMRI detects a suspicious area, a real-time MRI guided targeted biopsy facilitates pinpoint diagnosis and treatment matching.
According to a newly published article, “Prebiopsy MRI followed by targeted biopsy appears to have the ability to overcome the limitations of the standard 12-core template [biopsy].” The authors of the review point out that both the American Urological Association and the Society of Abdominal Radiology have issued consensus statements on the utilization of mpMRI prior to biopsy. Such statements affirm that the change in men’s health brought about by mpMRI is indeed progress especially when integrated with advances in biomarkers and standardized interpretation and reporting like PI-RADS.
Editors note: Prostate biopsies are a highly invasive procedure and have become entrenched in the medical system as the first line of diagnosis after a high PSA reading. Modern MRI imaging provides a more accurate targeting of potential cancer without the side effects and anxiety of having a prostate biopsy. If your Urologist won’t offer you this procedure before a biopsy then ask “why?”. We consistently have men emailing us saying that their Urologist doesn’t “offer it”[MRI] so “they” don’t think it’s necessary. If your Urologist doesn’t offer it then find one that will.
Copyright by Dan Sperling, MD. Reprint permission courtesy of Sperling Prostate Center (New York, Florida), the leading U.S. center for multiparametric detection, diagnosis and image-guided focal treatment of prostate cancer.
Read more in our Prostate Cancer Health Center.
Bjurlin MA et al. Role of MRI prebiopsy in men at risk for prostate cancer: taking off the blindfold. Current Opinions in Urology 2017 May; 27(3): 246-53