MRI for a investigation of an elevated PSA
MRI has overtaken trans-rectal ultrasound-guided biopsy, which was the mainstay of diagnosis in the past. The benefits of MRI are that it is non-invasive and highly accurate at detecting prostate cancer. It therefore improves safety and accuracy for investigation of men with an elevated PSA. It may eliminate the need for a biopsy in up too 25% of men with a mildly elevated PSA.
An MRI scan involves a 60 minute appointment at Bay Radiology where the staff will go through a comprehensive checklist with you. An MRI is a giant magnet, and it is important to make sure that you do not have any metal in your body prior to having the scan.
If you are prone to claustrophobia, it is wise to have a mild sedative beforehand. Please let us know if this is the case.
Lesions seen on the MRI
Radiologists use a classification system to determine the likelihood of there being prostate cancer on MRI scans. If there is a concerning lesion, we would proceed with a transperineal prostate biopsy under general anaesthetic.
Benefits of a transperineal prostate biopsy under general anaesthetic:
It is more comfortable
It avoids the risk of infection associated with a transrectal biopsy
We can target any suspicious area seen on MRI in 3 dimensions with a transperineal approach
An MRI will detect cancer if it is there about 90-95% of the time. We may recommend a biopsy even if your MRI is normal for several reasons. These include;
- You have a family history of prostate cancer
- You are young
- You have an elevated PSA density. This is a calculation involving the PSA according to the size of the prostate. If your PSA density is elevated (greater than 0.12), you have a higher risk of prostate cancer. In this situation, we usually recommend a biopsy.
If you have none of these concerning features, often you can just be observed. This involves ongoing PSA monitoring, and this can be with us, or with your GP.
We will contact you with the result of the MRI and make a plan from there.