MRI of the Prostate Before the Biopsy?

You have decided to get a PSA blood test and it is higher than expected. The test is repeated, and remains elevated. When you look at you PSA blood test year over year, it has increased with time. You have a discuss with your primary care doctor and it is their recommendation that you consider a biopsy. A referral is placed to a urologist. Yet, before seeing the urologist you ask yourself: “should I consider an MRI of my prostate before undergoing a biopsy?” The answer in most cases is “yes.” Let’s find out why.

Prostate cancer affects 1,600,000 million men globally and 165,000 men nationally in the Unites States each year. The PSA blood test is an important tool to help find prostate cancer, but it is not a perfect test. In many cases men who have a high PSA level undergo biopsy and are found to either have a low-grade cancer that never cause them any harm or no cancer at all. An MRI of the prostate gland can serve as a bridge to help determine if someone needs a biopsy. Furthermore, if a biopsy is needed, an MRI can help the doctor find the safest approach to obtain a tissue sample of the prostate gland.

Getting an MRI of the prostate gland before undergoing a biopsy has many benefits, including avoiding biopsies that are not needed. An MRI is a great imaging technique. Images are crisp and have a high resolution. An MRI can visualize different dimensions of the prostate gland and the structure around it. At times, a prostate doctor may look at the MRI and decide not to perform a biopsy. This is good news because such an approach can help avoid unnecessary biopsies.

At other times, the MRI can help the doctor see where a tumor is located. In this way, a more targeted and focused approach can be taken when attempting to get a sample of the prostate tissue. Fewer samples taken at the time of biopsy can led to fewer complications from a prostate biopsy. With a normal biopsy, 10-12 samples are taken in a systematic fashion of the prostate gland. With an MRI, typically less than half of the number of samples are needed. The doctor may decide to take a sample at the time an MRI or bring someone back later to get samples with the guidance of an ultrasound. At least the doctor knows where to direct their target. Therefore, the accuracy of a prostate biopsy can be improved with the use of an MRI beforehand as well.

In most cases, getting an MRI before a prostate biopsy is a good idea. Most urologist, or prostate doctors, follow this approach. When a high PSA blood test leads to a conversation with your primary doctor about a possible biopsy of the prostate gland, ask about the usefulness of a prostate MRI. You may be surprised to discover you may not need a biopsy at all.

REFERENCES
1. Benway BM & Andriole GL. Prostate Biopsy. In: UpToDate, Richie JP & Chen Wenliang (Eds), UpToDate, Waltham, MA. (Accessed on January 16, 2022.)