Did you ever read the name of a book or movie and think, “Wow, I wish I had thought of that title!”? I just read a poster presentation abstract from this year’s American Urological Association meeting (Boston, May 12-16, 2017). If the title weren’t already taken, it’s so good I might have used it for this blog: “Prostate MRI: The Truth Lies in the Eye of the Beholder.”[i] This means that the “beholder” better be very good at reading and interpreting multiparametric MRI (mpMRI) of the prostate.
These days, it’s getting easier to have a prostate scan done on a powerful 3T (3 Tesla) magnet. The advantages of 3T over the standard 1.5T magnets that are most widely available has to do with the resolution and fidelity of the resulting images (and of course, shorter imaging time for patients). Using a 3T magnet with great imaging software means the images will be superior in quality over those from a 1.5 magnet. However, this does not automatically mean that the quality of the interpretation will be better. Instead, how much experience the reader has with prostate MRI is what separates more accurate reports from less accurate.
This is exactly what the AUA paper is all about. The poster presentation by Dr. Joseph Riney (Penn State Health Mission) reviewed the work of his research team to compare the interpretations of less experienced and more experienced readers when reviewing the same scans. They based their research on 233 consecutive prostate cancer patients who were scheduled for prostatectomy and each had a pre-surgical 3T MRI whole body scan. The purpose of the scan was to detect any extracapsular extension (tumor spread outside the prostate) and seminal vesicle invasion before the patient went under the scalpel. Each scan was first read by a fellowship-trained body radiologist who was relatively inexperienced, followed by a senior radiologist who was blinded to the first person’s report.
As you may have anticipated, the more experienced senior radiologist’s second opinions were more accurate when correlated with the surgery results. What this tells us is that experience matters.
If you have recently had a 3T multiparametric MRI done to check out suspicion of prostate cancer, before you rely 100% on your report to make decisions about the next step, we invite you to contact the Sperling Prostate Center and arrange an expert second opinion. I can’t begin to tell you the number of patients who were either overdiagnosed or underdiagnosed by a first reader. Prostate cancer – or any cancer, for that matter – should always be taken seriously until proven otherwise. Why make decisions with potentially inadequate or incorrect information? If you are interested, contact the Sperling Prostate Center to make arrangements to send us your image CD. You will be glad you did.
[i] Riney JC, Sarwani NE, Siddique S, Raman JD. Prostate MRI: The Truth Lies in the Eye of the Beholder. Poster presentation, 2017 American Urological Association (May 12-16, Boston, MA). https://www.urotoday.com/conference-highlights/aua-2017/aua-2017-prostate-cancer/95582-aua-2017-prostate-mri-the-truth-lies-in-the-eye-of-the-beholder.html