By Mehul Bhakta, MD
According to the National Cancer Institute, prostate cancer is the third most common cancer in the United States. Although many prostate cancers won’t impact a person’s health during his lifetime even without treatment, some are more aggressive and can lead to serious health issues, and death, if not treated.
Know Your PSA
Those at increased risk for prostate cancer include African American men and men with a family history (father or brother) of prostate cancer. Historically, serum prostate-specific antigen (PSA) and digital rectal exams (DRE) have been the initial tests performed to screen for prostate cancer in men without symptoms. A PSA is a simple blood test with a normal value usually considered to be less than 4 nanograms per milliliter (ng/mL). PSA values can be elevated for a number of reasons, but the most concerning reason is prostate cancer.
If an abnormality is found, a transrectal ultrasound (TRUS) guided prostate biopsy is usually performed, which is a random, nontargeted biopsy in which 10-12 samples are usually obtained. If positive, a prostate MRI is then usually obtained to evaluate the extent of the disease. MRI scans can provide a clear image inside the prostate and show if the cancer has spread outside of the prostate.
Biopsy May Not Be Needed
One study has shown that prostate MRI has a much better sensitivity for the detection of prostate cancer than TRUS biopsy (93 percent versus 48 percent). In other words, the chances of missing a clinically significant cancer are much lower with a prostate MRI than with a TRUS biopsy. Furthermore, prostate MRI is noninvasive and provides additional information such as cancer location within the gland, cancer size, involvement of adjacent structures and detection of abnormal pelvic lymph nodes – all of which could impact treatment.
Prostate MRI can help guide which patients with an elevated PSA warrant biopsy, which can be uncomfortable, versus active surveillance, where the patient is closely monitored for the development of clinically significant cancer. If a biopsy is warranted due to a positive MRI, a prostate MRI can also provide information that would allow for a more targeted biopsy.
Talk with your doctor if you think prostate cancer screening is the right choice for you.