21 Mar, 2023
Prostate cancer is the second most common cancer in men worldwide. It can be challenging to diagnose early as it often shows no symptoms. However, early detection is crucial for successful treatment. Magnetic Resonance Imaging (MRI) is a non-invasive test that can help detect prostate cancer, guide biopsies, and investigate whether prostate cancer has spread. In this article, we will discuss how prostate cancer is diagnosed, the difference between normal MRI and MPM prostate MRI, and the various treatment options available.
A prostate cancer diagnosis would normally consist of a combination of different tests. Examples of these include:
The PSA blood test measures the amount of prostate-specific antigen in the blood. A raised PSA level can indicate an enlarged prostate or prostate cancer. If your PSA level is high, your doctor may recommend further tests.
During a DRE, a doctor will feel the prostate to check for any abnormalities. If the doctor suspects prostate cancer, they may recommend further testing.
A prostate biopsy involves taking small tissue samples from the prostate gland to test for cancer cells. The biopsy is taken with a thin needle, and sent to a lab for analysis. A prostate biopsy is the main method for diagnosing prostate cancer, but it may be combined with other examination methods such as MRI.
MRI uses strong magnetic fields and radio waves to produce a detailed picture of the inside of the body. It is a non-invasive test that can check for abnormalites, and help plan whether a biopsy is necessary. It can also help determine the extent of how much the cancer cells have spread, and check the surrounding tissues, bones and lymph nodes.. Prostate MPM (multiparametric) is a special type of MRI specifically used for imaging of the prostate gland. Sometimes MRI is used to determine and guide where a biopsy should be taken from.
A traditional MRI scan produces images of the prostate gland that help doctors determine whether prostate cancer is present. However, magnetic resonance spectroscopic imaging (MRSI) and magnetic resonance imaging (MRI) have been combined to produce an MRI scan that is highly sensitive to prostate cancer. This imaging technique is called multi-parametric MRI (MPMRI), and it can help doctors detect prostate cancer at an early stage.
The difference between a normal MRI and MPMRI is that MPMRI uses several imaging techniques to produce a more detailed picture of the prostate gland. These techniques include:
T2-weighted imaging: Produces images that show the structure of the prostate gland.
Diffusion-weighted imaging: Produces images that show the movement of water molecules in the prostate tissue, which can help detect cancerous areas.
Dynamic contrast-enhanced imaging: Uses a contrast agent to produce images that show the blood flow to the prostate gland.
The combination of these imaging techniques produces a highly detailed picture of the prostate gland, making it easier for doctors to detect cancerous areas. This can be especially helpful for men with elevated PSA levels, a family history of prostate cancer, or other risk factors.
Compared to a standard MRI, MPM prostate MRI has several advantages. Firstly, it can provide better visualisation and localisation of cancerous lesions in the prostate gland. Secondly, it can help identify early-stage prostate cancer that may not be visible on a standard MRI. Finally, MPM MRI can help guide targeted biopsies of suspicious areas in the prostate gland, which can improve the accuracy of prostate cancer diagnosis.
MPM prostate MRI does have some limitations. The technique is not always routinely available, and the cost of an MPM MRI scan may be higher than a standard MRI if accessed privately. However, the higher price tends to include a contrast agent and the range of techniques used in the study. Additionally, the interpretation of MPM MRI scans requires specialised training and expertise, which may not be available in all healthcare centres, though it is available via Scan.com.
MRI is typically used in diagnosing prostate cancer when:
The PSA (prostate-specific antigen) level is elevated in blood test results
The DRE (physical examination) suggests an abnormality
Previous biopsy samples suggest cancerous cells
A patient is on active surveillance
MRI can detect prostate cancer cells that may not be visible on ultrasound or CT scans.
MRI can provide a detailed picture of the prostate gland, allowing doctors to determine the extent of cancer spread.
MRI is non-invasive and does not require the use of radiation.
MRI can help doctors determine the best treatment options for patients.
MRI can produce false-positive or false-negative results, leading to further tests or missed diagnoses. Therefore, a combination of tests will usually be used to diagnose prostate cancer.
Prostate MPMRI requires the use of a contrast agent, which some people may be allergic to.
Patients with metal implants, shrapnel in their body, or medical devices such as cochlear implants and pacemakers may not be suitable for MRI due to a risk of the high-strength magnets interacting with metal in the body.
While the PSA test and DRE are commonly used to screen for prostate cancer, the most accurate test for prostate cancer is the prostate biopsy. However, this procedure can be uncomfortable, and it may miss small cancerous areas in the prostate gland. To increase the accuracy of prostate cancer diagnosis, doctors may also use imaging tests such as magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), or computed tomography (CT) scans.
Prostate cancer cells typically appear as dark areas on a T2-weighted MRI image. These dark areas indicate that the cancer cells are less dense than the surrounding healthy tissue.
In addition to T2-weighted images, other MRI sequences may also be used to help diagnose and stage prostate cancer. For example, a diffusion-weighted imaging (DWI) sequence can show how water molecules are moving within the prostate tissue, and areas of restricted diffusion may indicate the presence of cancer cells. A biopsy is normally required to definitively confirm cancer cells are present, and this can be guided by MRI scans.
It is important not to try and interpret your own MRI images without the expertise of a radiologist, who is a highly trained doctor specialising in the interpretation of diagnostic imaging tests. They will be able to help you understand what the images show, in simple terms that you can understand, and provide recommendations about what to do next.
If prostate cancer is diagnosed, there are several treatment options available, including active surveillance, radiation therapy, surgery, hormone therapy, and chemotherapy. The choice of treatment will depend on several factors, such as the stage and grade of cancer, the patient's overall health, and the patient's preferences.
Active surveillance involves monitoring the cancer closely and treating it only if it grows or spreads. Radiation therapy uses high-energy radiation to kill cancer cells. Surgery involves removing the prostate gland and surrounding tissue. Hormone therapy involves blocking the hormones that fuel prostate cancer growth. Chemotherapy involves using drugs to kill cancer cells.
Prostate cancer is a common disease that affects millions of men worldwide. MRI is a non-invasive imaging technique that can help diagnose and monitor prostate cancer. Standard MRI can detect suspicious areas in the prostate gland, but MPM MRI is a more advanced technique that provides better visualization and localization of cancerous lesions. MPM MRI can help guide targeted biopsies and improve the accuracy of prostate cancer diagnosis. However, MPM MRI is a relatively new technique that may not be widely available and requires specialized training and expertise for interpretation.
MRI is an accurate tool in diagnosing prostate cancer and is typically used when other tests indicate a potential problem. While it is not without its disadvantages, the benefits of MRI in detecting prostate cancer cannot be overstated. Early detection of prostate cancer can lead to successful treatment and increased survival rates. If you have any concerns about your prostate health, speak with your doctor about whether an MRI scan is right for you.
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