If you've watched any of the videos in this series, you've no doubt picked up on the fact
that the random needle biopsy, as a diagnostic tool, is a thing of the past. Or at least
it should be.
If you have not heard this, here's a quick recap.
For most men, the next step after a high PSA test result is the random needle biopsy which
involves using a large needle to remove samples called "cores" from different areas of the
prostate. The cores are examined under a microscope and judgments are made about whether cancer
is present or not.
The needle biopsy has big problems. First, it's invasive. Men can suffer from temporary
erectile dysfunction as a result of the biopsy and about 2-3% of the men undergoing these
biopsies get infections, some of which are very serious. Most importantly though, is
the fact that the random needle biopsy is not very accurate. It can miss serious cancer
or it can pick up low-level non-aggressive cancers that really don't require treatment.
Okay, so it should be a thing of the past. Why? New imaging technologies have rendered
the random needle biopsy obsolete. We're talking about multi-parametric MRI scans using the
3 Tesla or 3T machine. This technology can see into the prostate and identify suspicious
areas. Biopsies, if and when they're needed, are now targeted right at that suspicious
area or areas if they're present. No more random sticking. The problem is that many—if
not most—doctors you'll deal with are either unfamiliar with the technology or unwilling
to stop doing business as usual.
Let's talk about the MRI—magnetic resonance imaging. Taking pictures of your organs to
detect abnormalities like tumors. The latest generation of MRI scanners are called, as
I mentioned before, 3 Tesla or 3T scanners. There are also 1.5 Tesla Scanners still in
use. The problem with the 1.5 T scanners is that they have a lower resolution than the
3T scanners. They can't see as well. The 3T scanners have such high-resolution that any
tumors they can't see, aren't worth worrying about.
Multiparametric refers to the fact that the MRI scanner takes three different types of
pictures. It's essentially three scans in one. The results of each single type of scan
can be compared with the other two so nothing is missed. So, again, multiparametric MRI
using a 3T scanner.
One more reason that the 3T scanners are superior to the older technology is the fact that a
device called an endorectal coil is not needed to achieve high-resolution images. The coil
is essentially an antenna that's inserted into the rectum and a balloon surrounding
it is inflated to keep it in place. Sounds like fun, huh? Well, it's not. So it's a good
thing that we don't need them anymore with the 3T machines.
Once you have the right machine, you need the right people. The center you go to must
have operators and radiologists who are experienced doing and reading prostate scans. There's
a listing of centers that do this scan at PCRI.org. The list is not all-inclusive, so
you can look for research centers close to you. If the center has the right machines
and the right people with the right experience, you'll be okay.
So how about the scan itself? The center you use will let you know what preparations you
need to take care of the day before. If you have metal in your body, be sure to let your
doctor in the center know about it beforehand. Things like pacemakers, stents, staples, implants,
shrapnel, etc. may make it impossible for you to have an MRI scan. If you're a welder
or have done a lot of welding in the past, let them know that too in case there are small
fragments of metal in your eyes. They'll x-ray your head first to make sure there are no
fragments before doing the MRI. Before the scan, an IV will be inserted into your arm.
This is used to inject a contrast dye for one part of the scan to make the images more
vivid and informative. You may need a blood test performed prior to the day of the scan
to make sure that the contrast dye is safe for you.
Needles are not fun, but that's really the worst part of the experience. The scan itself
is painless. You need to lay as still as possible for about 45 minutes. The technicians are
generally really good about using strategically placed pillows to make you comfortable. The
machine is a large tube and it's a bit tight inside. If you have problems with tight spaces,
talk to your doctor about using a mild sedative, like diazepam, to take the edge off the anxiety.
The results of the scan will take anywhere from a few hours to a few days to be completed.
Make sure that you have directed the center to send the results to your doctor or doctors
and you should also get a copy for your medical folder. If possible, get a disc containing
the scan images in case you need it for a second opinion.
Now for the tough part. How to talk to your doctor. Maybe it won't be tough for you. If
your doctor immediately suggests that you go for an MRI followed by a targeted biopsy
if needed, you're golden. End of discussion. But if, as is more likely, your doctor is
going to want you to have the random needles biopsy, things could get a bit sticky. You're
gonna need to hold your ground. Politely explain to your doctor that you understand that there
are risks associated with the biopsy. Make it clear that you're not doing this because
you're afraid of the discomfort but that you are concerned about the very possible side
effects of erectile dysfunction and infection, and most importantly the fact that the biopsy
could miss serious cancer. Then ask him or her to order a multiparametric MRI with a
3T machine. If you've done your research, you can tell him or her what center you'd
like to use. If he or she refuses, sorry to say this but it's time to find a new doctor.
It may take a while, you may need to interview a few doctors, but you will find a physician
who is forward-thinking enough to forego the conventional wisdom. Remember, this is your
body. Your health care. You need to take responsibility. You need to take control.