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The Science of Prostate MRI

Technological advancements in the science of magnetic resonance coupled with the invention of more sensitive, targeted antennae, MRI scans can now generate highly-detailed 360° images of the prostate anatomy. With new research and scientific developments in this diagnostic field developing every day, prostate MRI is emerging as the new standard of care for prostate cancer screening. To help our patient and referring physicians learn more about the science behind prostate MRI, we have collected a series of peer-reviewed, academic papers presented here: 

Diagnostic Accuracy of a Rapid Biparametric MRI Protocol for Detection of Histologically Proven Prostate Cancer

Obmann VC, Pahwa S, Tabayayong W, Jiang Y, O'Connor G, Dastmalchian S, Lu J, Shah S, Herrmann KA, Paspulati R, MacLennan G, Ponsky L, Abouassaly R, Gulani V

"Rapid MRI detected clinically significant cancers with a sensitivity of 95.1% with a negative predictive value of 95.1% and positive predictive value of 53.2%, leading to a change in management in 10.8% of the patients. False negative rate of biparametric (bp) MRI was 4.7%."

Adverse Prostate Cancer Pathology Accurately Predicted With MRI

Jody A Charnow

"It is known that patients with PCa and adverse pathologic features, such as ECE, LNI, and high-risk Gleason score have a higher rate of biochemical recurrence after treatment. MP-MRI is an important and emerging imaging tool for determining adverse pathologic features and guiding treatment. “This could provide assistance in the selection of patients appropriate for active surveillance vs active treatment and aid in determining their prognosis,” Dr. Rai told Renal & Urology News."

ASCO GU 2018: Ability of multiparametric MRI to predict prostate tumor heterogeneity on targeted biopsy

Samuel Gold, Jonathan Bloom, Graham R. Hale, Kareem Rayn, Sherif Mehralivand, Brad J. Wood, Baris Turkbey, Peter A. Pinto

"The authors concluded that mpMRI aids in characterizing prostate cancer lesion heterogeneity to predict variability of histologic grades on targeted. This information may assist targeted planning to potentially reduce risks of upgrading on final pathology."

Quantitive MRI could advance prostate cancer detection

Wayne Forrest

""ROC analysis showed that increased epithelium and reduced lumen volume are very effective markers for the diagnosis of prostate cancer," the authors wrote. "The area under the ROC curve for differentiation of cancer from normal prostate was highest for fractional volume of epithelium (0.991), followed by fractional volumes of lumen (0.800) and stroma (0.789).""

AUA 2018: Negative MRI: Which Patients Could Safely Avoid Prostate Biopsy?

Masakatsu Oishi, Thomas B. Smyth, Owings Mills, MD, Toshitaka Shin, Chisato Ohe, Luis Medina, Akbar Ashrafi, Giovanni Cacciamani, Sunzanne Palmer, Manju Aron, Ronald F Tutrone, Owings Mills, MD, Osamu Ukimura, Inderbir S. Gill, Andre Luis de Castro Abreu

"Clinically significant cancer was detected in 38% of men in the MRI-targeted biopsy group, compared to 26% in the TRUS biopsy group (p=0.005)."

Can biparametric MRI accurately detect prostate cancer?

Michael Walter

"Research from the last 17 years shows that biparametric MRI (bpMRI) gives radiologists an accurate tool for detecting prostate cancer (PCa), according to a new meta-analysis published by the American Journal of Roentgenology."

MRI scans could put an end to prostate cancer biopsies

Giles Sheldrick

"DEADLY prostate cancer could be detected more accurately using MRI scans, new research suggests."

Biparametric MRI improves Detection of Significant PCa

Natasha Persaud

"Biparametric magnetic resonance imaging (bpMRI) may improve detection of significant prostate cancer (PCa) while reducing overdetection of insignificant cancers and needless biopsies in men with clinical suspicion of disease, according to the authors of a new study."

Faster MRI Protocol avoids unneeded prostate biopsies

Wayne Forrest

"The use of a streamlined MRI protocol could help reduce unnecessary biopsies by as much as 30% in men suspected of having prostate cancer, according to a study published online on June 8 in JAMA Network Open."

Simple Biparametric MRI in Detection and Ruling Out Significant Prostate Cancer in Biopsy-Naïve Men

Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre

"Dr. Boesen concluded that a low-suspicion bpMRI has a high NPV in ruling out significant prostate cancer on confirmatory biopsies in biopsy-naive men. Combining targeted biopsy and systematic biopsy only in men with moderately/highly suspicious bpMRIs is the preferred approach and allows for 30% of men to safely avoid prostate biopsies, improves significant prostate cancer diagnosis by 13% and reduces insignificant prostate cancer diagnosis by 40% compared to the current diagnostic standard ─ systematic biopsy in all men. Using bpMRI as a triage test improves risk stratification and may be used to exclude aggressive disease and avoid biopsies with its inherent risks."

Diagnostic accuracy of a rapid biparametric MRI protocol for detection of histologically proven prostate cancer

Verena C. Obmanna; Shivani Pahwaa; William Tabayayong; Yun Jianga; Gregory O'Connorf; Sara Dastmalchiana; John Luf; SohamShaha; Karin A.Herrmanna; Raj Paspulatiab; Gregory MacLennan; LeePonsky; Robert Abouassaly; Vikas Gulaniabde

"Rapid biparametric MRI discovered 176 lesions identified in 129 patients. Rapid MRI detected clinically significant cancers with a sensitivity of 95.1% with a negative predictive value of 95.1% and positive predictive value of 53.2%, leading to a change in management in 10.8% of the patients. False negative rate of biparametric (bp) MRI was 4.7%."

A Magnetic Resonance Imaging–Based Prediction Model for Prostate Biopsy Risk Stratification

Sherif Mehralivand, MD; Joanna H. Shih, Ph; Soroush Rais-Bahrami, MD

"MRI risk model may reduce the number of unnecessary biopsies among patients with suspected prostate cancer."

Unnecessary Prostate Biopsies Can Be Avoided With MRI-Based Risk Prediction Model

Dave Levitan

“When MRI was incorporated into a prediction model, it exhibited improved model fit and superior diagnostic accuracy, reducing unnecessary biopsies while maintaining a similar level of sensitivity for high-risk cancers."

Evolving Utilization of Pre-Biopsy Prostate MRI in the Medicare Population

Rosenkrantz AB, Hemingway J, Hughes DR, Duszak R Jr., Allen B Jr., Weinreb JC.

"Historic Medicare claims provide novel insights into dramatically increasing adoption of MRI prior to prostate biopsy. Following earlier minimal usage, utilization increased sharply beginning in 2013, exceeding 10% in 2015. However, substantial racial and geographic variation in adoption exists. Continued educational, research, and policy efforts are warranted to optimize the role of pre-biopsy MRI and minimize sociodemographic and geographic disparities."

The Clinical Value of Performing an MRI before Prostate Biopsy

Myung Sun Choi, MD; Yong Sun Choi, MD; Byung Il Yoon, MD; Su Jin Kim, MD; Hyuk Jin Cho, MD; Sung Hoo Hong, MD; Ji Youl Lee, MD; Tae-Kon Hwang, MD; Sae Woong Kim, MD

A study over 154 patients concluded that the prostate cancer detection capabilities of MRI are very accurate specifically in detecting small lesions and early stage disease. Therefore, prostate MRI conducted before a prostate biopsy can provide more information to identify prostate cancer during a biopsy.

Abbreviated Prostate MRI (AP-MRI)

Robin Bruhn, MD; Simone Schrading, MD; Christiane K. Kuhl, MD

A study conducted of 222 German men found that abbreviated prostate MRI (AP-MRI) without an endorectal coil or contrast agent offers the same diagnostic accuracy of MP-MRI for men with elevated PSA levels. The study showed a 93% sensitivity rate with an 89% specificity rate. 

MRI Twice as Likely as Biopsy to Spot Prostate Cancer, Research Shows

Recent research published in the Lancet Medical Journal led by the University College of London has shown that MRI is twice as likely as biopsy to spot prostate cancers. The study of 740 men over 3 years showed the MRI picks up 93% of aggressive cancers, while biopsy only picks up 48% of cancers. 

Impact of Common Medications on Serum Total Prostate-Specific Antigen Levels: Analysis of the National Health and Nutrition Examination Survey

Steven L. Chang, MD; Lauren C. Harshman, MD; Joseph C. Presti, Jr, MD

A study conducted over 1,864 men over 5 years by the Department of Urology at Stanford University School of Medicine found that many common medications have reduced levels of PSAs. The study reviewed NSAIDs, statins, and thiazide diuretics. 

Mode of Prostate Cancer Detection is Associated with the Psychological Wellbeing of Survivors: Results from the PiCTure Study.

Frances J. Drummond, MD; Eamonn O’Leary, MD; Anna Gavin, MD; Heather Kinnear, MD; Linda Sharp, MD

A team of researchers based in Ireland conducted a study among 6,559 prostate cancer survivors to determine the psychological impact of diagnostic methodology. Researchers found that prostate cancer survivors diagnosed with asymptomatic PSA-detected disease were at lower risk of negative mental health impacts such as anxiety and depression as those with symptomatically clinically diagnosed disease.

Cutting prostate cancer diagnosis times

BBC News - Health

The NHS plans to cut prostate cancer diagnosis time from six weeks to a matter of days using mpMRI. mpMRI provides higher quality imaging and can give up to 40% of patients answers the same day.

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New prostate MRI rebate marks end of unnecessary, painful cancer biopsies

Esther Han

"With a detection sensitivity of over 85 per cent, the prostate cancer MRI detects cancer at least twice as reliable as ultrasound, elastography or the usual punch biopsy," its CEO Jane Endacott said.

 

Professor Shomik Sengupta, ​ UroOncology Advisory Group Leader of the Urological Society of Australia and New Zealand. "An MRI that does not show any cancer is reliable; it is at least 90 per cent accurate in precluding cancer.""

Upfront MRI Could Rule Out Prostate Ca in Most, Reduce Biopsy Need

Pam Harrison

"Among 1,020 men who underwent both bpMRI and standardized transrectal (TRUS) biopsy, low-suspicion bpMRI had a negative predictive value of 97% in ruling out significant prostate cancer (95% CI 95%-99%), reported Lars Boesen, MD, PhD, of Herlev Gentofte University Hospital in Denmark, and colleagues."

AUA 2018: Using Multi-parametric Magnetic Resonance Imaging and Targeted Biopsy to Rule Out Seminal Vesicle Invasion in Prostate Cancer

Samuel Gold, Zachary Klaassen

"This is a provocative study demonstrating feasibility of using mpMRI to evaluate and target biopsy the seminal vesicle. Important clinical implications include preoperatively knowing that seminal vesicle invasion is present, and thus making sure of a wide excision at the prostate base/seminal vesicles. A limitation of the model is the likely overfitting of the statistical model with almost certain variable collinearity. From their results, the authors concluded that high-grade prostate cancer biopsy from the prostate base and MRI evidence of seminal vesicle invasion or extraprostatic extension are significant features associated with increased risk of seminal vesicle invasion. Furthermore, absence of base lesions or benign base biopsy are very strong negative predictors. In fact, the authors argue that even if the SVs are unable to be examined on MRI, inclusion of these features still yields strong predictive value at pre- and post-biopsy stages."

MRI Scans Can Avert Many Prostate Biopsies

Jody A Charnow

"Multiparametric magnetic resonance imaging (MRI) of the prostate prior to biopsy can safely decrease the number of unnecessary biopsies and increase the number of significant prostate tumors diagnosed compared with standard biopsy, according to the findings of an international randomized trial presented at the 33rd Annual European Association of Urology Congress in Copenhagen, Denmark, and published concurrently in the New England Journal of Medicine."

EAU 2018: Multiparametric-MRI/Ultrasound Fusion Prostate Biopsy: Are Two Biopsy Cores Per MRI-Lesion Required?

Zachary Klaassen, MD

"The authors concluded that in 89% of patients with mpMRI/ultrasound fusion prostate biopsy detected prostate cancer, the use of one single targeted biopsy core is sufficient to properly identify prostate cancer. Among lesions with detected prostate cancer, the first biopsy core is also sufficient to properly evaluate Gleason grading. As such, it seems to be justified not to perform more than one targeted biopsy core from a suspicious MRI lesion. Thus, costs and risk of complications might be reduced without limiting the diagnostic yield of MRI and MRI-guided biopsy."

Could MRI reduce the need for prostate cancer biopsies?

Highlights of the 2018 European Association of Urology Congress

"MRI scans can reduce the number of invasive prostate biopsies by up to 28%. This was the finding of a major international study presented at EAU18 and published in the New England Journal of Medicine."

NHS adopts mpMRI scanning tech to slash prostate cancer diagnosis times

Digital Health

"The NHS has adopted new scanning technology which it claims can slash diagnosis times for prostate cancer, while also reducing the risk of  sepsis."

MRI-based prediction model may reduce unnecessary biopsies in prostate cancer

Mehralivand S

"Including MRI-derived parameters in a prediction model reduced the number of unnecessary biopsies while still detecting a high rate of clinically significant prostate cancers among men, according to findings published in JAMA Oncology."

Unnecessary Prostate Biopsies Can Be Avoided With MRI-Based Risk Prediction Model

Dave Levitan

“When MRI was incorporated into a prediction model, it exhibited improved model fit and superior diagnostic accuracy, reducing unnecessary biopsies while maintaining a similar level of sensitivity for high-risk cancers."

Evolving Utilization of Pre-Biopsy Prostate MRI in the Medicare Population

Rosenkrantz AB, Hemingway J, Hughes DR, Duszak R Jr., Allen B Jr., Weinreb JC

Historical Medicare claims provide novel insights into the dramatically increasing adoption of magnetic resonance imaging prior to prostate biopsy. Following earlier minimal use the performance increased sharply beginning in 2013, exceeding 10% in 2015. However, substantial racial and geographic variation exists in adoption. Continued educational, research and policy efforts are warranted to optimize the role of prebiopsy magnetic resonance imaging and minimize sociodemographic and geographic disparities..

ESOU18: Biopsy or Monitoring Patients with Negative MRI

Hanan Goldberg, MD and Jonas Hugosson, MD

"MRI targeted biopsies can improve detection of clinically significant cancers (90% sensitivity), especially in the anterior aspect of the prostate. It can also decrease the detection rate of non-significant cancers."

How well can MRI detect lymph node metastasis in patients with bladder and prostate cancer?

Michael Walter

Researchers with the American Journal of Roentgenology have found MRI can detect lymph node metastasis in patients with prostate cancer with high specificity. 

Higher accuracy in the diagnosis of the prostate cancer

Klinik für Prostata-Therapie GmbH

Researchers have found most biopsies are redundant. Modern  combination of MRI imaging procedures gives more precise results leading to progress in the diagnosis of the prostate cancer in the Heidelberg Clinic for Prostate Therapy.

Urologists support single PSA test for men

Sarah Wiedersehn

"Imaging the prostate using MRI scans and targeted biopsies of identified abnormalities help increase the detection of significant cancers and reduce the over-diagnosis of indolent cancers."

Abbreviated Prostate MRI (AP-MRI)

Robin Bruhn, MD; Simone Schrading, MD; Christiane K. Kuhl, MD

Abbreviated prostate MRI, if confirmed by further studies, may open the door for systematic MRI screening for prostate cancer.

MRI Twice as Likely as Biopsy to Spot Prostate Cancer, Research Shows

Recent research published in the Lancet Medical Journal led by the University College of London has shown that MRI is twice as likely as biopsy to spot prostate cancers. The study of 740 men over 3 years showed the MRI picks up 93% of aggressive cancers, while biopsy only picks up 48% of cancers. 

Impact of Common Medications on Serum Total Prostate-Specific Antigen Levels: Analysis of the National Health and Nutrition Examination Survey

Steven L. Chang, MD; Lauren C. Harshman, MD; Joseph C. Presti, Jr, MD

A study conducted over 1,864 men over 5 years by the Department of Urology at Stanford  University School of Medicine found that many common medications have reduced levels of PSAs. The study reviewed NSAIDs, statins, and thiazide diuretics. 

Mode of Prostate Cancer Detection is Associated with the Psychological Wellbeing of Survivors: Results from the PiCTure Study.

Frances J. Drummond, MD; Eamonn O’Leary, MD; Anna Gavin, MD; Heather Kinnear, MD; Linda Sharp, MD

A team of researchers based in Ireland conducted as study among 6,559 prostate cancer survivors to determine the psychological impact of diagnostic methodology. Researchers found that prostate cancer survivors diagnosed with asymptomatic PSA-detected disease were at lower risk of negative mental health impacts such as anxiety and depression as those with symptomatically clinically diagnosed disease.

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