What is the problem with rushing to biopsy after an elevated PSA test result?

The problem with rushing to biopsy after a suspiciously high PSA blood test lies in the number of men who go through the biopsy procedure only to have a negative report. Did you know that

• Roughly 20 million PSA tests are done each year in the U.S.?
• An estimated 1 million prostate biopsies are done annually but at least 70% do not have prostate cancer?^[i]

A biopsy is necessary to prove that prostate cancer is present, but the procedure itself has risks. “Prostate biopsies can be uncomfortable and lead to prolonged bleeding and infections,” write Michael David and Stephen Leslie, but MRI before biopsy “…can eliminate 25% to 30% or more of low-yield biopsies by better identifying patients unlikely to have clinically significant (Gleason grade 4) disease.”^[ii]

Why doesn’t every man with a high PSA have an immediate MRI?

Even though clinical guidelines advise that a suspicious PSA should be followed with an MRI before rushing to biopsy, there are many challenges to implementing such a program. The economic barrier is the most obvious, since specialized MRI costs far more than standard in-office ultrasound-guided biopsy.

A less obvious hurdle is the MRI scan itself. In addition to significantly fewer imaging facilities that are equipped with advanced 3 Tesla (3T) magnets, and expert radiologist readers to assure the accuracy of multiparametric MRI before biopsy, meeting the demand to scan thousands more men would face huge inefficiencies. Facilities would be overburdened due to the long scanning time (with possible patient movement confounding results)—not to mention labor-intensive processing and image interpretation.

This second hurdle is where Artificial Intelligence (AI) can help.

How can AI minimize inefficiency while boosting accuracy?

When AI is integrated into multiparametric MRI of the prostate, it captures enhanced resolution, defining even small areas containing probable significant prostate cancer. Not only does this increase speed, it supports accurate image interpretation even for less-experienced radiologists.

MRI engineers continue to develop AI programs to increase radiologist efficiency without sacrificing excellence in diagnosis, treatment planning, treatment guidance, and post-treatment monitoring. For example, the division of Siemens AG that manufactures healthcare magnets has created an AI program called Deep Resolve® which “accelerates prostate MRI acquisition while maintaining diagnostic image quality. A peer-reviewed study demonstrated approximately 39% shorter diffusion-weighted imaging acquisition times compared with conventional workflows,” reports a Healthcare-in-Europe newsletter. The article also identifies another AI software that boosts “key post-processing tasks, including prostate segmentation, volume estimation, lesion detection…” and other tasks, reducing post-processing interpretation by as much as 80% for negative MRI cases.

These and other innovative developments offer the promise that honoring expert recommendations to make MRI scans widely available before biopsy is within reach. In such ways, AI is serving a major need in men’s health to avoid over-biopsy and over-detection of low-risk prostate cancer that may never become life threatening.

NOTE: This content is not intended as an endorsement of any manufacturer or product. This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Biddle C, Brasel A, Underwood W 3rd, Orom H. Experiences of Uncertainty in Men With an Elevated PSA. Am J Mens Health. 2017 Jan;11(1):24-34.
[ii] David MK, Leslie SW. Prostate-specific antigen. National Library of Medicine. Sep. 10, 2024. https://www.ncbi.nlm.nih.gov/books/NBK557495/