What does an MRI of the prostate have in common with surgery or radiation treatment for prostate cancer (PCa)? The answer is the importance of skill. A specialist’s skill makes a difference. “The specific specialist that a patient sees can have a large influence on the type of care they receive.”[i] While bedside manner appeals to patients emotionally, the fact is that some doctors simply deliver better results.
The most important factor in best results is skill. No one is born skilled. The only way to develop it is through repeat experience. Take the case of a urologic surgeon who does radical prostatectomy (RP). “[M]uch of the variation in functional outcomes after prostate cancer surgery arises from differences in technical skill,” says a paper by Schroek, et al. [ii] This is illustrated by another study that found a large gap in recurrence rates between surgeons who had performed 10 operations vs. those who had done 250. Patients treated by the more experienced doctors were much more likely to be cancer-free at 5 years after treatment.[iii] Results based on experience are what save lives.
The same principle applies to radiation treatment for PCa. The Prostate Cancer Foundation advises, “Just as surgical skill can play an important role in determining outcomes from prostatectomy, the technical skill of your radiation oncologist can play an important role in radiation outcomes. When choosing a radiation oncologist, look for a physician who has broad experience with an assortment of approaches and can objectively help you decide on the best course of treatment.”
Experience in prostate imaging
When it comes to prostate MRI, of course the power of the magnet is important. Magnet strength is measured in units called Tesla, or T. Most conventional magnets are 1.5T, but stronger magnets such as ours are 3T. At either strength, there are two types of prostate MRI that can be done:
- biparametric MRI (bpMRI) uses two scanning sequences called T2-weighted (the T stands for Transverse Relaxation Time, not Tesla) and diffusion weighted imaging
- multiparametric MRI (mpMRI) uses the two listed above, plus dynamic contrast enhancement that uses injection of a contrast agent to look for tumor blood flow.
3T magnets produce images with higher resolution in order to detect differences between normal vs. cancerous prostate tissue. Also, mpMRI provides more information than bpMRI because of the contrast agent. Although mpMRI scans take longer than bpMRI scans, authorities agree that 3T mpMRI is the ideal imaging method for PCa.
In addition, doctors and patients alike know that experience matters! Just as a PCa patient about to be treated wants the physician who has a solid history doing his procedure, men suspected of having PCa want the imaging center with the radiologist who has the longest consistent history reading prostate mpMRIs done on a 3T magnet—even into the thousands, says a Dec. 2023 study by Ziayee, et al. [iv]
The Ziayee paper reports their research comparisons between bpMRI vs. mpMRI, and between less experienced readers. The goal was the best detection of clinically significant PCa depending on reader experience. Their study population consisted of 124 consecutive patients who had 3T mpMRI followed by both targeted and systematic biopsies. Fifty-three (43%) had biopsy results diagnosing clinically significant disease.
Two sets of radiologists read the mpMRI and bpMRI scans, and all were blinded to the biopsy results:
- Less experienced readers (R1) were those whose previous experience consisted of less than 500 prostate MRIs
- Expert radiologists (R2) were those who had done more than 5,000 prostate MRIs.
The authors note, “The primary endpoint was the performance comparison of mpMRI versus bpMRI of R1 and R2.”
They found that “Less experienced readers missed a relevant proportion” of clinically significant PCa with mpMRI and even more with bpMRI. A factor for the superior detection of mpMRI was the addition of dynamic contrast enhancement which picked up additional PCa. In any case, as I posted in a previous blog, when it comes to excellence in prostate imaging, experience is the “dominating factor.”
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] Jiang T, Stillson CH, Pollack CE, Crossette L et al. How Men with Prostate Cancer Choose Specialists: A Qualitative Study. J Am Board Fam Med. 2017 Mar-Apr;30(2):220-229.
[ii] Schroeck FR, Jacobs BL, Hollenbeck BK. Understanding variation in the quality of the surgical treatment of prostate cancer. Am Soc Clin Oncol Educ Book. 2013:278-83.
[iii] Vickers AJ, Bianco FJ, Serio AM, Eastham JA et al. The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst. 2007 Aug 1;99(15):1171-7
[iv] Ziayee F, Schimmöller L, Boschheidgen M, Kasprowski L et al. Benefit of dynamic contrast-enhanced (DCE) imaging for prostate cancer detection depending on readers experience in prostate MRI. Clin Radiol. 2023 Dec 14:S0009-9260(23)00579-2.
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.
