Originally published 11/10/2014
During the decade since we posted the blog below, dreams came true for hundreds of thousands of men around the world who were able to avoid an unnecessary prostate biopsy—thanks to multiparametric MRI (mpMRI).
Numerous studies between then and now have validated the hypothesis that if mpMRI does not detect significant prostate cancer (PCa), no biopsy is needed; but if a biopsy is indicated, MRI-targeted biopsy overcomes the problems of the TRUS random biopsies. It minimizes the number of needles while maximizing diagnostic accuracy.
As one paper states, “…MRI targeted biopsies detect more clinically significant disease and reduce overdetection of indolent disease whilst allowing between one-third to one half of men to avoid an immediate biopsy.”[i]
For those who object adding MRI to the diagnostic pathway on the basis of cost, the authors add, “Cost effectiveness data show that using MRI to determine who gets a biopsy and how that biopsy is done is a cost-neutral approach when men at lowest risk do not undergo biopsy.”
To come at it another way, unnecessary random biopsies are costly in healthcare dollars. They lead to additional tests, overtreatment, and management of biopsy/treatment side effects. Thus, a straight line from a suspicious PSA test to an MRI scan is in everyone’s best clinical and economic interest.
For those not familiar with the name of California oncologist Mark Scholz, MD, he is the co-author of a book provocatively titled “Invasion of the Prostate Snatchers.” Currently, he is the Medical Director of Prostate Oncology Specialists, and also serves as Executive Director of the Prostate Cancer Research Institute. As a respected authority on prostate cancer, and an advocate of getting correct information to patients, when Mark Scholz speaks he has my attention.
In an article in the patient publication Prostate Cancer Communication (Fall, 2014)[ii] Dr. Scholz’s opening salvo goes to the core problem of over-treating men with low grade cancer. He observes,
While the PSA blood test has been fingered as the problem, overuse of random needle biopsies is the real issue. Over a million men undergo biopsy every year to evaluate the possibility of harboring cancer. Few people realize, however, that random biopsy reveals low-grade prostate cancer in one out of five men in the general population—even when PSA is normal.
He goes on to say that despite the known risk of side effects, 85% go ahead with radical treatment.
Slowly, as the extent of over-diagnosis and over- treatment is dawning on patients, doctors, professional organizations and even the U.S. Government, solutions are being explored. The simplest, most elegant solution—the one discussed in Dr. Scholz’s article—is imaging.
Basically, today’s imaging such as our 3T multiparametric MRI can detect suspicious lesions with a high degree of accuracy, even higher when done by an expert on state-of-the-art equipment. Imaging before biopsy is essential for two reasons:
- It can determine whether a biopsy is truly necessary at that time, and
- If so, it can guide a targeted biopsy that requires a minimum number of needles yet yields the greatest accuracy.
I have had the good fortune to meet Dr. Scholz over a dinner. Although we’re located on opposite shores and practice two different specialties, we share a professional common ground when it comes to the best way to serve patients’ needs. I wholeheartedly agree Dr. Scholz’ premise that the conventional use of random biopsy is the true culprit, driving men into overtreatment.
If you are interested in our 3T mpMRI guided biopsy, contact us for a consultation.
NOTE: 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] Giganti F, Moore CM. MRI in early detection of prostate cancer. Curr Opin Urol. 2019 Nov;29(6):563-568.
[ii] Scholz, Mark. Imaging is superior to random biopsy. Prostate Cancer Communication, a publication of PAACT (Grand Rapids, MI). 2014;30(3):10.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
