MRI’s, biopsies and prostate cancer

Getting an MRI might eliminate the need for a prostate biopsy.

There is the ongoing controversy over whether men should be screened for prostate cancer (see discussion here). Prostate cancer is very common, however most of the time it stays local and never causes problems. The current medical evidence suggests that surgically treating prostate cancer does not ultimately improve survival. Treating prostate cancer can result in a cure which is worse than the disease, such as impotence and urinary incontinence.

Even the question of whether to get screened for prostate cancer is not a simple one. Although the means is a simple blood test, the problem is that the presence of a high number (which is a sign of the possibility there could be cancer) requires further evaluation in the form of a trans-rectal biopsy. A trans-rectal biopsy involves a large needle being pushed through the rectum and into the prostate, taking a small piece of the prostate for analysis.

Bottom line, a prostate biopsy is not fun and certainly not something you want to do if it can be avoided.

There was a recent study published in The Lancet that I found noteworthy. In short, if a man goes to get a blood screening and has a reading indicative of possible cancer, an MRI scan can be done. MRI’s detect the vast majority of cancers. If an MRI is negative, the study suggests that the man can safely skip the biopsy. In total, MRI’s would cut the need for biopsies by 27%. In other words, if blood screening is positive, a subsequent MRI would determine one in four men to not have cancer, such that they could skip the biopsy.

If relevant to you or a loved one, if there’s a need/recommendation to get a prostate biopsy, perhaps ask your doctor about getting an MRI first. There is a strong chance you won’t need that biopsy after all. This remains an evolving field.

SOURCES: PSA, Old Controversies, New Results. Harvard Medical School Prostate KnowledgeNational Cancer Institute; Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study

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