Posted on Sep 25, 2019
This year, the American Cancer Society estimates that nearly 175,000 men will be diagnosed with prostate cancer (about 1 in 7 men). But despite being the most common cancer among men, excluding skin cancer, there’s no ‘one size fits all’ solution for determining prostate cancer risk.
So how can men find a balance between avoiding the drawbacks of screening, while also ensuring nothing goes undetected? Prostate MRI, combined with a second opinion, could be the answer.
There are two forms of prostate cancer: aggressive and harmless. Fortunately, out of all prostate cancer cases, only a fraction will be aggressive and clinically significant. The majority will never impact the well-being or life expectancy of a patient.
Prostate MRI can help reduce the number of men who are over-diagnosed (diagnosed with cancer that does not go on to cause any harm during their lifetime) by 5%.
A prostate MRI scan enables radiologists to better differentiate between aggressive and harmless cancers by providing information about a tumor’s size, density, and proximity to the bloodstream. One study comparing prostate MRI to biopsy found MRI scans to correctly diagnose 93% of tumors, whereas biopsy correctly diagnosed only 48%. Identifying non-threatening forms of prostate cancer helps decrease the risk of overdiagnosis and overtreatment.
But do keep in mind that MRIs can be complex images for radiologists to interpret. Coupling a prostate MRI with a subspecialty second opinion from a fellowship-trained radiologist can help maximize the advantages and efficacy of the screening. This can be done completely online and is especially recommended for scans that indicate the possibility of aggressive prostate cancer.
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Prostate biopsies are used to confirm cancer in high-risk patients suspected to have aggressive prostate cancer. Uncomfortable and invasive, men undergoing the procedure are extremely prone to complications like antibiotic-resistant infections and sepsis. It’s estimated that 18% of patients experience some sort of complication, while as many as 4% develop an infection requiring hospital care.
27% of the one million prostate biopsies performed each year are unnecessary.
Typically, a biopsy will be recommended to a patient for one of two reasons: they tested high for levels of the PSA (prostate specific antigen) protein, or, the results from a digital rectal exam show they may have prostate cancer. The issue here is that PSA tests are not always accurate.
A male’s PSA level can be affected by a number of other factors, such as recent sexual activity, an enlarged prostate, and prostatitis. Even a long bicycle ride can cause levels to spike. This leaves a lot of room for false-positives - which lead to unnecessary biopsies.
Adding prostate MRI to the screening process offers a less intrusive and more accurate method to determine risk by identifying tumors that are slow-growing, non-threatening, and better left alone. One study, published by The Lancet, found that prostate MRI could help one in four men avoid biopsy. In another study, by JAMA Oncology, researchers found that using prostate MRI scans to determine the need for biopsy could have avoided 38% of biopsies and still identified 89% of clinically significant cancers.
When a doctor performs a biopsy, multiple tissue samples are taken at random. While this method technically has the capability to find cancer, it can easily miss the cancerous parts of the prostate. In such cases, a repeat test may be ordered. This means another uncomfortable and expensive procedure, and also doubles a patient’s already high exposure to infection.
Getting a prostate MRI before a biopsy allows radiologists to identify exact areas in the prostate that are suspicious for cancer so that they can be marked as the best targets for a needle biopsy. Advanced technology can then fuse MRI images with real-time ultrasound to help guide the prostate needle biopsies to the specific areas of concern. This increases the accuracy of diagnoses, reduces the risk of infection from the procedure, and helps accelerate treatment planning for positive patients.
As mentioned above, prostate MRIs are complex images. Getting a second opinion by a subspecialist before undergoing biopsy can further improve the accuracy of the procedure, as well as the overall diagnosis. Benign prostatic hyperplasia (BPH), enlarged prostate, and bacterial prostatitis can often be mistaken as prostate cancer. A second opinion can help rule out these conditions before proceeding with treatment.
Ultimately, prostate cancer screening is a personal decision. The frequency and type of prostate cancer screening that’s right for one individual may differ vastly from another. For help determining your risk, it’s always best to first consult your doctor to discuss options.
How accurate is MRI in diagnosing prostate cancer?
Compared with biopsy alone, MRI with or without targeted biopsy was associated with a 57 percent improvement. in the detection of clinically significant prostate cancer and a 77 percent reduction in the number of cores taken per procedure.
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