The Prostate Specific Antigen (PSA) test measures blood levels of a protein made by prostate cells. Elevated PSA levels in the blood have many causes including cancer, prostatitis, Benign Prostatic Hyperplasia (BPH), and following ejaculation, biopsy or surgery. In most cases an increased PSA level is not due to cancer. Yet, a relatively high percentage of men with “normal” PSA levels may have significant cancer.
In May of 2012, the US Preventive Services Task Force issued recommendations against routine screening of prostate cancer with PSA concluding that “many men are harmed as a result of prostate cancer screening and few, if any, benefit. A better test and better treatment options are needed.” Click HERE to read the full recommendations.
While these recommendations continue to be debated, it is clear that PSA screening for prostate cancer has significant limitations. There are an unacceptable number of false positives (abnormal PSA but no significant cancer) leading to other testing including biopsies and treatment. At the same time, there are a high number of false negatives (normal PSA in patients that have significant cancer) which give a false sense of security and may delay additional necessary testing and treatment.
Many of these uncertainties are solved with the use of Multiparametric 3T MRI of the kind provided by Partners Imaging Centers. Partners use post processing and computer aided detection (CAD) software specifically designed for prostate patients. In addition, customized scanning protocols are used to produce the most optimal images of the prostate that are interpreted by Dr. Richard Goldberg, an experienced prostate radiologist.
Historically, many urologists have been skeptical of MRI scans of the prostate and choose not to refer their patients for an exam. This view had some merit in the past when imaging was anatomic based only, did not include functional parameters, had inadequate MRI scanners and protocols, and lacked the expertise for proper image interpretation. This situation has changed dramatically with the advanced imaging and experienced radiologist interpretation of the type that is provided at Partners Imaging.
An increasing consensus among physicians is that MRI imaging is now an important tool in detecting and staging of prostate cancer. If your physician disagrees, consider obtaining another opinion. Countries such as the United Kingdom will not perform a prostate biopsy in the National Health Service without an MRI first. In the United States, Medicare very early on approved payment for an MRI exam for men at risk for prostate cancer.
An MRI will determine with high accuracy whether there is significant disease or not within the prostate. If you have an elevated PSA or other risk factors with a normal PSA, a multiparametric 3T MRI should be your next step.