Our Summary

The research paper looks at the impact of a specific type of MRI scan (multiparametric MRI or mpMRI) on the detection of prostate cancer. Traditionally, a process called transrectal ultrasound is used during a biopsy to identify cancer, but it’s not very accurate. This study found that, if the mpMRI is done before the biopsy, it increases the chance of finding aggressive prostate cancer and decreases the chance of finding slow-growing (indolent) prostate cancer. This means doctors can choose which patients to biopsy more effectively. Currently, this method is not included in the health services provided in Israel.

The study looked back at the data of men who had prostate biopsies over the past 30 months. In cases where the mpMRI showed something suspicious, extra samples were taken during the biopsy. They found that prostate cancer was detected in 46% of all men, and this rate was higher (61%) in men who had an mpMRI before the biopsy compared to men who didn’t (38%). This difference was even more pronounced in men having their first biopsy.

In conclusion, the study suggests that having an mpMRI before a prostate biopsy significantly increases the chances of detecting prostate cancer. Therefore, it is recommended to have an mpMRI before any prostate biopsy, in line with guidelines from European and American Urology Associations, and the National Comprehensive Cancer Network (NCCN).

FAQs

  1. What is the impact of a multiparametric MRI (mpMRI) on the detection of prostate cancer?
  2. Does having an mpMRI before a prostate biopsy increase the chances of detecting prostate cancer?
  3. Are mpMRIs before prostate biopsies recommended by major health organizations?

Doctor’s Tip

Based on this research, a doctor might recommend to a patient undergoing a prostate biopsy to ask about the possibility of having a multiparametric MRI (mpMRI) done beforehand. This can help improve the accuracy of detecting aggressive prostate cancer and reduce the chance of detecting slow-growing cancer, ultimately leading to more personalized and effective treatment decisions.

Suitable For

Patients who are typically recommended for a prostate biopsy include those with elevated levels of prostate-specific antigen (PSA) in their blood, abnormal digital rectal exam findings, or other risk factors for prostate cancer such as a family history of the disease. Additionally, patients who have had a previous negative biopsy but still have concerning symptoms or risk factors may also be recommended for a prostate biopsy.

Timeline

Before the prostate biopsy:

  • Patient may experience symptoms such as frequent urination, difficulty urinating, or blood in urine.
  • Patient may undergo a digital rectal exam (DRE) to check for any abnormalities in the prostate.
  • Patient may undergo a PSA blood test to measure levels of prostate-specific antigen.
  • If results are abnormal, patient may be recommended to have a multiparametric MRI (mpMRI) scan to further evaluate the prostate.
  • Based on the mpMRI results, the patient may be advised to undergo a prostate biopsy.

After the prostate biopsy:

  • Patient may experience discomfort or pain in the rectal area or when urinating.
  • Patient may notice blood in urine or semen for a few days after the procedure.
  • Pathology results from the biopsy will determine if prostate cancer is present and if treatment is needed.
  • If cancer is detected, patient may undergo further tests to determine the stage and aggressiveness of the cancer.
  • Treatment options such as surgery, radiation therapy, or active surveillance may be discussed with the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostate biopsy in light of this study include:

  1. Can I have a multiparametric MRI (mpMRI) before my prostate biopsy to increase the accuracy of detecting prostate cancer?
  2. How will the results of the mpMRI impact the decision to proceed with a biopsy?
  3. What are the potential benefits and risks of having an mpMRI before a prostate biopsy?
  4. Will having an mpMRI before the biopsy affect the type of treatment or monitoring plan recommended for me?
  5. Is mpMRI before a prostate biopsy covered by my insurance or healthcare provider?
  6. Are there any specific criteria or guidelines I need to meet to be eligible for an mpMRI before a prostate biopsy?
  7. How reliable is the mpMRI in detecting aggressive prostate cancer compared to traditional methods?
  8. How will the results of the mpMRI be used in conjunction with the biopsy results to determine my treatment plan?
  9. Are there any potential limitations or drawbacks to having an mpMRI before a prostate biopsy that I should be aware of?
  10. What are the next steps after the biopsy in terms of monitoring or treatment options based on the results of the mpMRI and biopsy?

Reference

Authors: Dothan D, Mamber A, Kafka I, Eddin Natsheh A, Shenfeld O, Zilber S, Benyaminov O, Chertin B, Koulikov D. Journal: Harefuah. 2021 Sep;160(9):576-581. PMID: 34482669