Importance of Quality MR imaging for Diagnosing Prostate Cancer
When a patient presents with elevated prostate-specific antigen and/or an abnormal digital rectal examination, the common next step in the work up for prostate cancer is a core needle biopsy under transrectal ultrasound (TRUS) guidance. Prostate cancer is not always reliably visualized with ultrasound, so the TRUS is primarily used to direct the needle into various anatomic regions of the prostate.
Sextant biopsy techniques have been shown to miss up to 50% of small tumors (1). This has led to the more widespread adoption of “saturation biopsy” techniques where 8 to 22 cores are obtained in a single biopsy session focusing on the transition zone or using a perineal template. However, lack of suitable tools to locate cancer within the prostate means that, even with saturation biopsy protocols, initial biopsy may fail to reveal cancers in up to 30% of men (2).
The use of MRI imaging has gained popularity over the past 10 years with using multi-parametric techniques (T2 weighted, Diffusion weighted and Dynamic contract enhancements). These techniques help point out suspicious tumors and get a better look if advanced cancers are invading into or outside the prostatic capsule helping with staging. Using MRI images fused with TRUS has assisted with the targeted biopsy methods and has reduced the number of repeated biopsies.
The importance of high-quality MRI imaging cannot be under stated and may significantly reduce the number of biopsies and possibly the number of core samples needed when the suspicious areas are identified before the procedure.
Several centers continue to use endorectal MRI coils such as the eCoil, where the signal-to-noise ratio (SNR) is increased to help the radiologist’s confidence when identifying the areas of concern on the multiparametric images.
In summary, about 70,000 men annually will undergo two or more repeat prostate biopsy procedures. And with the bigger picture, approximately 1,000,000 prostate biopsy procedures performed each year to diagnose approximately 240,000 cases of prostate cancer, there is a clear need to reduce the number of repeat biopsies to prevent unnecessary costs while ensuring that all clinically significant cancers are diagnosed and treated as soon as possible.
So, why not consider using an endorectal coil from the beginning to reduce the probability of infection and misdiagnosis and get it done right the first time which will increase the quality of care for the patient?
1.Levy DA, Jones JS. Management of rising prostate-specific antigen after a negative biopsy. Curr Urol Rep 2011;12:197–202.CrossRefPubMedGoogle Scholar
2.Ukimura O, Coleman JA, de la Taille A, Emberton M, Epstein JI, Freedland SJ, et al. Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol 2013;63:214–30.CrossRefPubMedGoogle Scholar