Sinking your mental teeth into a banquet of information can be as satisfying as sitting down to a 5-course feast. At least, that’s how I felt when I came across a well-written review called “Multiparametric MRI in Diagnosis of Prostate Cancer” by Sangeet Ghai and Masoom A Haider.[i] I personally think it’s well worth reading, but be prepared for numerous technical terms like “morphologic” and “pharmacokinetic” that require frequent use of the internet to obtain definitions.
Here are some takeaway points that I’ve been writing about in my articles and blogs:
- Conventional TRUS biopsy overdetects insignificant prostate cancer (PCa) and underdetects anterior tumors until they are dangerous. This leads to inaccurate risk stratification and therefore mismatched treatments.
- A 3T magnet does not require use of an endorectal coil, and provides better quality images than a 1.5T magnet.
- The main parameters that can be used in various combinations are T2 weighted MRI (anatomic detail), diffusion weighted imaging (movement of water molecules in tissue), dynamic contrast imaging (tumor blood flow), and MR spectroscopy (metabolic biomarker differences between healthy cells and cancer).
- The most essential data is provided by combining T2 weighted and diffusion weighted imaging, which has been shown to be highly accurate. Adding in dynamic contrast and spectroscopic sequences can provide clarifying information.
- Training radiological readers on the simplified reporting system called PI-RADS makes interpretations more accurate and objective.
- Multiparametric MRI (mpMRI) should be done before biopsy in patients whose PSA and/or DRE are suspicious for PCa.
- mpMRI has a higher detection rate than another repeat biopsy for men who had one or more previous negative biopsies.
- mpMRI can help qualify men for active surveillance, and can be monitored by imaging. Together with tracking PSA, a suspicious change in a patient’s MRI is a better trigger for biopsy than monitoring PSA alone.
- MRI-guided targeted biopsy is preferable to conventional TRUS biopsy.
The authors cite 71 references, so you know they have “done their homework” in summarizing the current state of mpMRI. Interested readers who want to access those sources can use pubmed.com to find the abstracts (brief summaries) of the actual articles.
I continue to write about mpMRI in order to reach as many newly diagnosed PCa patients as possible. Many of them are not aware that such imaging exists, let alone how vital the information is before considering a biopsy. This excellent work underscores the value of mpMRI. Although reading it may require frequent stops to visit Wikipedia and other explanatory sites, it’s not that long and yet gives a wealth of information and data. Feel free to spread the word. The whole article is available here, if you want a worthwhile mental workoout.
[i] Ghai S, Haider MA. Multiparametric MRI in diagnosis of prostate cancer. Indian J Urol. 2015 Jul-Sep; 31(3): 194–201.