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Studies Favor MRI In Prostate Cancer Detection

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Studies are defining an ever-larger role for MRI in detecting prostate cancer. One of the most recent, performed by Australian researchers, found MRI to be 97 percent effective in ruling out prostate cancer for men with abnormal prostate specific antigen levels or digital rectal exam results.

Lead Investigator Phillip Stricker, MBBS, senior author of an article about the research in the July issue of The Journal of Urology, said the findings could be particularly helpful in sparing men with false positive PSA tests the discomfort, expense, and infection risk of a biopsy:

There’s been a lot of controversy about PSA testing over the years. This may take a lot of the controversy away. You’ll be able to see what’s real and what’s not real, and we won’t find these unnecessary, insignificant cancers, which are the big controversy.

Dr. Stricker is chair of the urology department at St. Vincent’s Private Hospital in Sydney, Australia, and director of the St. Vincent’s Prostate Cancer Centre. He was quoted in an Australian Broadcasting Corporation story.

The research, which involved 150 men older than 40, found that MRI was much better at detecting the absence of cancer than at detecting cancer itself. Positive predictive values ranged from 43 percent to 71 percent, depending on the level of risk predicted by the PSA and digital tests.

MRI also seems to be gaining favor for guidance of prostate biopsies. Research presented in May at the meeting of the American Urological Association in Orlando, Florida, found that prostate biopsies using MRI guidance were more likely to find aggressive tumors than those that relied on ultrasound. Gerald L. Andriole, MD, chief of urologic surgery at Washington University School of Medicine and Barnes-Jewish Hospital, both in St. Louis, gave the presentation, described in a Washington University news release.

And an article in the September issue of The Journal of Urology reports on a study that concludes, “Use of magnetic resonance imaging for targeting prostate biopsies has the potential to reduce the sampling error associated with conventional biopsy.”

Dr. Andriole said he thought MRI prostate screening would eventually be as much a gold standard as mammography. “In the future, if a man has an elevated PSA, we’d like to do an MRI and be so confident in the technology that we’d only do a targeted biopsy if the MRI were positive. We’re not there yet, but that’s the goal.”

Related CME seminar (up to 12.5 AMA PRA Category 1 credits™): UCSF Abdominal & Pelvic Imaging: CT/MR/US


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