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The American Urological Association Now Recommends Prostate MRI Before Biopsy

“There is now sufficient data to support the use of prostate MRI in all men before their initial prostate biopsy when the MRI is of sufficient quality."
- Marc A. Bjurlin, DO, MSc., AUA Policy Statement Co-Author

 

Multiparametric prostate MRI (mpMRI) recently received a huge boost when the American Urological Association (AUA) released a statement supporting its use.

Prior to the updated AUA statement, urologists commonly ordered a trans-rectal ultrasound-guided biopsy for men with elevated PSA and/or other risk factors for prostate cancer. Unfortunately, this “random” approach only samples about 1% of the prostate gland. Studies have shown that these biopsies miss about 20-25% of all malignancies1 and generally underestimate the disease. When disease is found through a TRUS biopsy it can often lead to overly aggressive treatment that may not be required.

What’s more, the biopsy can be painful and result in side-effects such as bleeding, infection, blood in the semen, blood in the urine, difficulty urinating and sexual dysfunction.

mpMRI, on the other hand, enables doctors to better visualize the entire prostate gland in a completely non-invasive way. This test can help to rule out the need for a biopsy, or if one is needed, it can ensure that biopsies are taken from the most suspicious areas—and not just randomly. The test is safe, accurate and painless, and has been shown to identify cancer in more than 50% of men whose initial biopsy was negative.2

It is estimated that with widespread use of mpMRI as a front line screening tool, more than 1/3 of all prostate biopsies could be avoided.3

The updated statement was revealed after an expert panel from the AUA and the Society of Abdominal Radiology evaluated the latest clinical data on the use of mpMRI, recommending its use in “all men without previous history of biopsy under consideration for prostate biopsy.” The report also indicated that mpMRI must be adequately performed on the right equipment and requires high-quality interpretation by a skilled radiologist—key factors that are in place at HALO Diagnostics but that are not available at all diagnostic imaging centers that perform MRI.

MRI can also be used to guide biopsies more precisely than ultrasound. HALO Diagnostics is one of the few outpatient centers in the region capable of performing MR-guided biopsies; this service is typically only available in a hospital environment. An MR-guided biopsy can ensure sampling is conducted from only the most suspicious areas of the prostate, which can potentially reduce both discomfort and the side effects of biopsy.

mpMRI is now recommended for:

  • Patients at high risk for prostate cancer
  • Patients with suspected prostate cancer (elevated PSA with or without a negative biopsy)
  • Patients with biopsy-proven prostate cancer

To read the entire AUA statement, please visit: https://www.auanet.org/guidelines/mri-of-the-prostate-sop

 

1. Babaian RJ, Toi A, Kamoi K, et al. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol. 2000;163:152–7. doi: 10.1016/S0022-5347(05)67993-1.
2. Study published June 2011 UCLA David Geffen School of Medicine
3. Haffner J, Lemaitre L, Puech P, Haber GP, Leroy X, Jones JS, et al. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int. 2011;108:E171–8