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MRI of the Prostate

MRI for a investigation of an elevated PSA

 

In the past we have used transrectal ultrasound-guided biopsy as the main way to investigate an elevated PSA. Multi-parametric MRI has overtaken transrectal biopsy. The benefits of MRI are that it is non-invasive, and highly accurate at detecting prostate cancer. For this reason, it improves safety and accuracy for investigation of men with an elevated PSA.

 

An MRI scan involves a 60 minute appointment at Bay Radiology. If you are prone to claustrophobia, it is wise to have a mild sedative beforehand. Please let us know if this is the case. In addition, 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. We will go through a checklist with you, and the Bay radiology staff will also go through a more comprehensive checklist.

 

What if there is a lesion seen on MRI?

Radiologists use a  classification system to determine the likelihood of there being prostate cancer on MRI scan. If there is a concerning lesion, we would proceed with a transperineal prostate biopsy under general anaesthetic. The beauty of doing this under general anaesthetic is that it is advantages for you for 3 reasons
1. It is more comfortable, as you under anaesthetic.

2. It avoids the risk of infection associated with biopsing through the back passage (transrectal biopsy)
3. We can target any suspicious area in 3 dimensions on MRI with a transperineal approach

 

What if my MRI is normal?

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;
1. You have a family history of prostate cancer
2. You are young
3.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.

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