The likelihood of having prostate cancer can be determined by digital rectal examination and a blood test which measures PSA, a protein secreted by normal prostate cells and in larger amounts by prostate cancer. The problem is that an elevated PSA does not definitely indicate prostate cancer as it can also be raised in non-cancerous conditions such as aging related enlargement, inflammation and infection. In fact certain activities like having sex or riding a bike can trigger a temporary increase in PSA that has nothing to do with prostate cancer and conversely a normal PSA does not exclude prostate cancer.
Systematic biopsies of the prostate until now have been the gold standard for evaluating raised PSA and prostate cancer diagnosis. Whilst they have been shown to save lives, biopsies have also been shown to detect relatively harmless, insignificant cancers which pose no real threat to a man’s life expectancy. Furthermore a biopsy sometimes will miss an aggressive cancer particularly if it is located in the front part of the prostate gland beyond the reach of the biopsy needle.
Prostate Multi-Parametric MRI is a non-invasive imaging test that has emerged recently as the best examination available for detecting significant (‘harmful’) prostate cancer earlier. It is also advantageous that MRI does not pick up harmless cancers which would lead to unnecessary overtreatment.
It also enables accurate evaluation of spread outside the prostate gland which is important when it comes to treatment options. Understanding the extent of disease enables the surgeon to determine whether it is possible to preserve the delicate arteries and nerves which are essential for maintaining sexual function and bladder control.
Pre Biopsy MRI
If your PSA is elevated many world experts consider it to be advantageous to have an MRI prior to a biopsy for the investigation of prostate cancer. In some patients MRI can be so convincingly negative that we can say more reliably than with biopsy that there is no significant cancer in the prostate. This means your doctor may decide not to proceed to a biopsy. The MRI will in essence give you peace of mind. If you and your doctor still decide to proceed to a biopsy your MRI will add considerably to the certainty that a significant cancer is not missed by the biopsy.
If cancer is detected on MRI, the MRI will give better information with regards to its location, size, grade and extent, important information that your Urologist needs when it comes to diagnosis and treatment planning.
Post Biopsy MRI
If you have already had a biopsy, which did not show cancer and your PSA is still raised or rising, a subsequent MRI can further evaluate for missed prostate cancer as a possible cause for your elevated PSA.
There is also evidence that MRI has added an extra dimension to the monitoring of men undergoing active surveillance or follow up after radical treatment, resulting in many fewer biopsies.
At Perth Radiological Clinic our mission is to provide doctors and most importantly our patients with un-paralleled precision diagnostic imaging such that decisions affecting your health can be made with confidence.
Perth Radiological Clinic now provides prostate MRI services at Joondalup (Shenton House) and Subiaco clinics.
Pictured above is Dr Basil Sclanders who leads our team of prostate specialist radiologists.