DRA's 3T MRI Helps in Prostate Screening

The new 3T Ultra High Field at DRA in Middlebury

It's no surprise that there is confusion surrounding the prostate-specific antigen (PSA) blood test. Recommendations for when men should have it vary and results are often unclear. Some doctors encourage yearly screenings for men over age 50. Some advise men who are at a higher risk for prostate cancer to begin screening at age 40 or 45. Others caution against routine screening altogether.

There is, however, general agreement that men should be informed about the potential risks and benefits of PSA screening before being tested so they, with the advisement of their primary care physician, can make an informed decision on what next step (s) to take. For example:

• When the PSA is normal, 15 percent of men still have prostate cancer
• When the PSA is abnormal, only 12 percent of men have prostate cancer

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. In 2012, The American Cancer Society estimates 241,740 men in the U.S. will be diagnosed with prostate cancer and 28,170 men will die from it. Adding to the confusion surrounding prostate cancer is that while one man out of every six will be diagnosed in their lifetime, most have slow-growing tumors that likely will not lead to death or require invasive treatment. It's also often difficult for urologists and radiation oncologists to determine the extent and expected behavior of prostate cancer and if deciding to treat it will actually help or just cause more worry or side effects.

Advances in diagnostic imaging are taking some of the worry and confusion away from managing this disease. By using modalities such as MRI, physicians have the opportunity to more accurately determine a patient's prostate cancer severity and minimize the number of prostate biopsies required, which is currently between12 and 30 samples. This can help reduce the estimated $2 million in costs to the healthcare system.

Currently, more than 1.2 million men in the U.S. have these biopsies each year but less than 15 percent come back positive for cancer. Without an optimal visual picture of the prostate and surrounding area, biopsy exams are essentially conducted "blindly." This can lead to missed cancerous lesions while unnecessarily oversampling other sections. While imaging of the prostate has historically been done with ultrasound, MRI offers clinicians improved image quality of the prostate gland to support better detection and localization of the area(s) of suspicion and helps pinpoint any specific regions of concern.

Similar to most advanced breast MRI studies, clinicians interpreting prostate MRIs often use an advanced image analysis system to support improved workflow and analysis of the contrast enhancement, such as iCAD's VividLook® technology currently being used in Middlebury at DRA. With this technology, we are able to better localize sites of potential cancer from within the complex vasculature of the prostate and give our patients and their referring physician's additional information to support a more accurate diagnosis and to help them plan the best treatment options. Advanced image analysis plays an important supporting role to the radiologists at DRA who are devoted to providing accurate diagnosis and the best patient care using the most advanced technology available.