Prostate Multiparametric Magnetic Resonance Imaging, a new diagnostic technique for prostate cancer

Since the introduction of Prostate Specific Antigen (PSA), which is a protein produced by prostate cells, the detection of prostate cancer is performed early and in less advanced stages.

The only method to demonstrate the presence of neoplastic cells in the prostate is the performance of a biopsy. This is performed under local anesthesia or sedation, transrectally or perineally and with the aid of an ultrasound scanner. The disadvantage of this diagnostic technique is the low specificity of the Prostate Specific Antigen (PSA) and the fact that ultrasound can hardly detect suspicious areas of cancer. This means that multiple biopsies have to be performed which continuously give negative results with a progressive rise in PSA.

In this situation, the urologist must ask himself when to propose a new biopsy (since this is not risk-free) and how to interpret the result of the biopsy in case it is negative, because of the possibility of a false negative result.

Currently there is an imaging test that reduces the number of biopsies that are performed and also reduces the possibility of obtaining false negative results. This test is Multiparametric Magnetic Resonance Imaging (MRI) and it has greater sensitivity for the detection of aggressive prostate cancers. In addition, it allows to guide the collection of samples and to focus on the most suspicious areas, reducing the probability of obtaining a false negative result.

Multiparametric Magnetic Resonance Imaging (MRI) of the prostate consists of a morphological T2 sequence (defines the shape, size and limits of the prostate) and three functional sequences DWI, DCE, MRS (diffusion, contrast and spectroscopy) which respectively study the density of the tissue, its uptake of contrast and its metabolic activity. All these parameters are collected in a score and give rise to a categorized report using the PI-RADS system in relation to the prostate’s segmented zonal anatomy.

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When should a multiparametric Magnetic Resonance Imaging (MRI) be performed?

Multiparametric Magnetic Resonance Imaging (mMRI) is indicated in the following cases:

  • Local staging of an already known prostate cancer, to select the most optimal treatment.
  • Persistent suspicion of prostate-specific antigen (PSA) elevation, with previous negative prostate biopsy and new indication for biopsy.
  • Control of local recurrence after prostate cancer treatment.

Multiparametric Magnetic Resonance Imaging (MRI) lasts approximately 40 minutes. A venous access must be placed for contrast perfusion and an endorectal device is placed; although it can also be performed with an external coil (not endorectal). No anesthesia or sedation is required.

This imaging technique, together with the appearance of new specific markers, has constituted a great advance in the field of diagnosis and treatment of prostate cancer, since it allows a more precise diagnosis of patients affected by this tumor and a better follow-up of patients with elevated Prostate Specific Antigen (PSA).