Prostate MRI Before Decision About Biopsy

This is an assessment for:

Birmingham Prostate Clinic routinely uses enhanced prostate MRI scans before making a decision about whether a biopsy for prostate cancer is necessary.

This is one of the areas in which we do things differently to many other urology clinics in order to provide patients with a more personalised diagnosis and avoid unnecessary interventions.

How are MRI scans used in prostate cancer assessments?

MRI technology has developed very significantly in recent years. This affords a new role for MRI in the understanding of prostate cancer. Traditionally, MRI was used to stage prostate cancer after a biopsy had confirmed the presence of cancer. The purpose of the MRI scan was confined to the assessment of how far the cancer had spread.

At Birmingham Prostate Clinic, our practice is to carry out an MRI scan before a biopsy, in order to assess whether a biopsy is necessary.

What are the benefits of MRI before biopsy?

  • The MRI scan, combined with other assessments such as the PSA, PCA3 and trans-rectal ultrasound, may show a biopsy is not necessary. Thus as intervention which patients find uncomfortable and carries its own risks may be avoided.
  • A biopsy traumatises the prostate tissue, so an MRI undertaken soon after a biopsy can be unclear due to this tissue damage.
  • By undertaking the MRI before biopsy, your surgeon has the benefit of an independent view of your prostate cancer, reported by the consultant radiologist.
  • Enhanced MRI is particularly important for men who have anterior prostate cancer – this means the cancer has developed at the front of the prostate. The anterior is particularly difficult to accurately reach and assess via trans-rectal ultrasound, so there is a danger of anterior prostate cancers being missed. There are no difficulties in visualisation using MRI. A quarter of all prostate cancers develop in the anterior lobes.

Case study example: a man has a high PSA for his age and so is referred to BPC. If his PCA3 test and MRI scan are convincingly negative, a biopsy is unlikely to be necessary. However, if the PCA3 and enhanced MRI are not available, a biopsy is likely to be used because the wider information is lacking.

“At BPC we work slightly differently to other services – I undertake the MRI before Mr Doherty does a prostate biopsy. The advantage of this is that the prostate tissue is not traumatised in any way by the biopsy and cause confusion. I can then provide Mr Doherty with an entirely independent view using MRI.”

Dr Ian McCafferty, consultant interventional radiologist, Birmingham Prostate Clinic.

MRI at BPC as part of a second opinion

We welcome patients who want to come to BPC for a second opinion. It is perfectly understandable that patients want to reassess their options and seek a different opinion in order to be sure that they are on the right treatment path. An MRI may be particularly helpful if you have an elevated PSA, but have had negative biopsies, because the MRI can support the identification of cancer (particularly in anterior lobes) or help to confirm there is no disease present.

About the enhanced MRI technology we use at BPC

There are two aspects of the new technology used at BPC in addition to more standard MRI technology:

Dynamic MRI

MRI scans have traditionally had a role in the staging of prostate cancer – telling us to what extent the cancer has spread within or outside the gland. At BPC, we use what is known as dynamic contrast-enhanced MRI. It is sometimes referred to as the ‘MRI movie’ because it does much more than a basic cross-section of the prostate; it goes through the prostate every 20 seconds for three minutes after contrast (dye) have been given into a small vein. This helps us to have a much clearer idea of whether the tumour is breaching the gland and whether the surrounding nodes are involved. This is particularly important if the surgeon is considering whether it is safe to undertake nerve-sparing surgery or whether it is necessary to use wider margins and remove some nerves in order to eradicate all cancer cells.

Diffusion Weighted-Imaging

This is another important development in MRI technology. Micro-movements of water are examined within the prostate gland, tumour cells demonstrate restricted movement whereas in normal tissues the movement is more free. This improves the confidence of BPC to the presence of prostate cancer. This technique can also be used to look at the nodes near to the prostate gland to decide how likely they are to be involved with cancer. Used in combination with standard prostate MRI and dynamic contrast enhanced MRI, this approach is really valuable in terms of assessing the whole prostate gland and nodes. These new techniques have improved the identification of prostate cancer and helps BPC to decide upon the best course of treatment.

“I believe that the advances in MRI technology and the application of those advances to prostate cancer assessment is probably the most significant development in the whole field of prostate cancer in recent years. It has transformed the way we assess prostate cancer.”

Alan Doherty, Consultant Urologist, Birmingham Prostate Clinic

“The task of the urologist is to judge where there is a small amount of slow-growing disease and avoid over-treating, but identify harmful, fast-growing cancer. Advanced MRI scans are an essential and very important tool in this task.”
Alan Doherty, clinical director Birmingham Prostate Clinic