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MRI Works Well For Grading Prostate Tumors

September 26, 2012
Written by: , Filed in: Abdominal Imaging
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The best thing to do for low-risk prostate cancer may be nothing. Well, “active surveillance” does involve keeping a watchful eye on the tumor, so it’s not exactly nothing. Still, many tumors will never progress to the point of being a serious health threat, so leaving them alone allows the patient to safely avoid surgery or other invasive treatment.

But it’s really, really important to make sure the tumor is truly low-risk. According to a new study, MRI can help.

Researchers from Memorial Sloan-Kettering Cancer Center in New York found that adding endorectal MRI to the initial clinical evaluation of men whose prostate cancer appears to be low-risk can sharpen the assessment of that risk. Their study was published online today in The Journal of Urology.

The researchers evaluated 388 prostate cancer patients. The patients had an initial biopsy, then an endorectal MRI, then another biopsy to confirm the initial diagnosis and assessment. Three radiologists with varying levels of prostate MRI experience read the scans.

When the radiologists scored the tumors as being low-risk, the second biopsy almost always confirmed that assessment. Not surprisingly, the more experienced radiologists got it right more often. So an MRI scan may allow at least some low-risk patients to avoid the pain and stress of a second biopsy. Lead investigator Hebert Alberto Vargas, MD, summed up the findings:

These results suggest that MRI of the prostate, if read by radiologists with appropriate training and experience, could help determine active surveillance eligibility and obviate the need for confirmatory biopsy in substantial numbers of patients.

Dr. Vargas works in the radiology department at Memorial Sloan-Kettering. He was quoted in a news release from Elsevier, publisher of The Journal of Radiology.

This won’t be the final word. But surgery and other invasive prostate cancer treatments commonly have such unpleasant side effects, including erectile dysfunction and bladder problems, that patients understandably would prefer to avoid them. And, according to Dr. Vargas, “The fact that clear tumor visualization on MRI was predictive of upgrading on confirmatory prostate biopsy suggests that prostate MRI may contribute to the complex process of assessing patient eligibility for active surveillance.”

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Related seminar: UCSF Abdominal and Pelvic Imaging: CT/MR/US


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