Are you considering a prostate MRI? If you’ve already seen Dr. Bevan-Thomas for an elevated PSA or have been diagnosed with prostate cancer, chances are he has recommended one for you. Here’s what you need to know about it.

WHAT IS A MULTIPARAMETRIC PROSTATE MRI?

The multiparametric MRI (mpMRI) is a fairly new technology used to image the prostate.

Urologists have been using ultrasound for years to do this, but prostate cancer can be difficult to visualize with ultrasound alone.

In the past 10 years, however, MRI technology has improved significantly. We are now able to use mpMRI to find abnormalities in the prostate with far greater detail and localization than we could with ultrasound alone.

SOUNDS GOOD, BUT HOW DOES IT WORK?

Dr. Bevan-Thomas recommends a T3 multiparametric MRI to take images of your prostate. Currently, he recommends Gateway Imaging in Arlington, Texas. The 3T mpMRI uses a 3 Tesla (3T) magnet to take multiple images. Each image type uses a different parameter to show a specific view of your prostate.

To put it simply, these are the four parameters:

• T2-weighted images: These give clear images of your anatomy and will show any suspicious areas in your prostate.
• Diffusion-weighted images (DWI): These images show contrast based on the movement of water molecules through prostate tissue, which helps to pinpoint areas of abnormal cells.
• Dynamic contrast-enhancement (DCE): DCE images blood vessels to find areas of abnormal blood flow that may be feeding a tumor.
• MRI spectroscopy (MRS): These images compare the chemical composition of normal and abnormal tissue to find suspicious areas.

The radiologist will then interpret these images and assign the abnormal area a PI-RADS score. Dr. Bevan-Thomas will also review these images and score the areas accordingly.

WHAT'S A PI-RADS SCORE?

The Prostate Imaging Reporting and Data System (PI-RADS) is a scale that’s used to determine how likely a suspicious lesion is to be cancerous. It’s based on a scale of 1 (not suspicious) through 5 (highly suspicious).

The PI-RADS scale also has two levels:

• Level one: Each of the four parameters above (T2, DWI, DCE, and MRS) is given a value of 1 through 5.
• Level two: The four numbers are added together. Some centers don’t use MRS, so in that case, they total the other three parameters.

This number is then used to assign a value of I, II, III, IV, or V to the suspect area. A score of I means the area is benign, and V means a high likelihood of cancer.

For example, in the chart below, if the total of T2, DWI, DCE, and MRS scores is 6, 7, or 8, then your PI-RADS classification would be II, probably benign.

PI-RADS CLASSIFICATION SYSTEM

OK, SO A PROSTATE MRI IS PRETTY IMPORTANT?

Yes! The mpMRI and PI-RADS score will give Dr. Bevan-Thomas detailed information that will help determine whether you need a prostate biopsy and if there is an area to target for the fusion biopsy. Before mpMRI technology, if a doctor suspected cancer, patients would go straight to an ultrasound-guided prostate biopsy. With the mpMRI, if your PI-RADS score is low — meaning low risk for intermediate or high-grade cancer — you may not need a biopsy.

A multiparametric prostate MRI is accurate for finding intermediate and high-grade cancers around 85% of the time. A negative MRI does not always mean that a biopsy is not recommended, but it is extremely helpful in finding lesions to target. There is roughly a 15% chance of having a focus of cancer not seen on the MRI, so other parameters are often used in terms of recommending a course of action. Ultrasound continues to have a role in diagnosing many prostate cancers.

But if your PI-RADS score is higher, you may need a fusion biopsy. In this case, the multiparametric MRI results will give Dr. B-T an exact location to target. By fusing the ultrasound image with the MRI image, a specific area can be targeted with a needle biopsy.

WHY DO YOU NEED A UROLOGIST WITH mpMRI EXPERIENCE?

Dr. Bevan-Thomas has experience with the most advanced technology — including the mpMRI — dating back to 2012. He was the first urologist in Arlington, Texas, to use the prostate MRI and fusion technology.

Why is that experience important? Because state-of-the-art equipment has a better chance of finding aggressive prostate cancer earlier in the disease process.

Dr. B-T will also support you throughout the process. He will review your MRI results with you prior to scheduling a biopsy. He will be sure that you understand the need for the biopsy, how the procedure is done, and the pathology results. He will then guide you through your treatment options, and together you will decide on the best course of treatment.