MRI Before Biopsy

Good question.

I was also wondering if this is the new standard of care?

Mel

I am very much against unnecessary testing, but in your case, it may be warranted at some point.

A normal MRI is certainly not needed for the first biopsy. (There are certain kinds of very specialized MRIs, called multiparametric MRIs that are used in certain situations that you do not fall into.) They will focus on the suspicious area identified on the DRE and take random cores throughout the back side of your prostate, where cancer is usually found if there is any cancer. They will do the same thing whether there is an MRI or not. Many nodules are not cancerous.

If cancer is identified on the biopsy, there is a risk that a 1 cm tumor at the base has penetrated into the seminal vesicles, or extended into the bladder neck, or surrounding tissues. I hope not, but if so, this would put you into a different risk category and change your eligibility for different treatment alternatives.

The real question is whether it should be done before or after the biopsy. If before, and it turns out that there was no cancer there - as is true in most biopsies - it will have been for nothing. If after, they will have to wait for about a month or two after the biopsy to let it heal because the aftereffects of the biopsy will interfere with reading the MRI. There is usually little risk in waiting. The advantage is that they won't be giving you an unnecessary test in the very likely event that there is no cancer. I think this is what most urologists would do. What does your urologist suggest?

- Allen

My urologist just emailed me with this:

I am already aware that MRI is currently being explored to help identify patient's that are at higher risk of having a positive prostate biopsy. Hopefully this can help decrease the amount of prostate biopsies being performed. This technique is not being used across the country currently since it is a newer concept. It is mainly used for people with elevated PSA only. You also have a nodule in your prostate and I think that we would perform a biopsy regardless of the MRI results. This is why I don't think we need to perform an MRI. Let me know if this does not make sense or if you have any other questions.

TrainGuy - good urologist!

My uro ordered an MRI before my biopsy. It came back negative but the biopsy was positive at G7

My urologist trained at MD Anderson was doing a pre-biopsy study utilizing 3T mpMRI and I was included within this study. He said a post biopsy mpMRI (or regular MRI) causes horrible images due to the damage (edema) caused by the biopsy.

With that said, I can tell you that in my case the 3T mpMRI with and without contrast took over 2 hours and included almost 3,000 images. With all of that technology the images showed only one suspicious area which he targeted for biopsy, and the results of that core was negative. You can see from my tag line that I had cancer in both lobes but relative low volume.

If a tumor can be palpable during the DRE or you have a fairly large volume of cancer or higher Gleason score the mpMRI will typical depict that on the images. Of course you don't know if you have a high Gleason score without the biopsy, so that is sort of a moot point.

For me, it was a no-brainer, I would rather utilizing technology and have negative or inconclusive results, then not using technology and regret it afterwards.

By the way I us to work for radiolgoy department (PACs support) of a very large teaching hospital and jump for any non-aggressive diagnostic tools.