Improved magnetic resonance imaging (MRI) may aid detection of prostate cancer

Nancy Ferrari

Senior editor, Harvard Health

Until recently, most professionals have been skeptical that magnetic resonance imaging (MRI) could be used on a widespread basis to diagnose or stage prostate cancer with any degree of reliability, and therefore help with making treatment decisions. One analysis of scientific literature published from 1984 to 2000 found that MRI was able to predict the stage of prostate cancer accurately anywhere from 50% to 92% of the time, depending on the facility and the skill of the radiologist. In other words, MRI staging was sometimes no better than a coin toss (see “Reason for skepticism,” below). Actual detection of tumors also depended largely on the skill and experience of the radiologist, and whether or not an endorectal coil was used to make the image clearer.

Reason for skepticism

American Urological Association. Prostate-Specific Antigen (PSA) Best Practice Policy. Oncology 2000;14:267–72. PMID: 10736812.

Engelbrecht MR, Jager GJ, Laheij RJ, et al. Local Staging of Prostate Cancer Using Magnetic Resonance Imaging: A Meta-Analysis. European Radiology 2002;12:2294–302. PMID: 12195484.

But MRI technology has substantially improved in the past few years, and some experts believe it may be time to reevaluate its use in guiding treatment decisions. A new generation of MRI devices and additional technological advances (contrast enhancement and special processing) are being used together — in select imaging centers — to generate amazingly clear images of the prostate.

In these images, even tiny areas of cancer can be revealed in color, enabling radiologists to determine exactly where a tumor is located in the prostate gland. The technology is so new that published data are sparse — yet promising. One study found the new techniques have a 95% accuracy rate (see “New generation MRI,” below). You can also see several examples of new generation images in Figures 1 and 2 below. Here, Dr. Rofsky, of Harvard’s Beth Israel Deaconess Medical Center, talks more about the new MRI technology, which patients might benefit from it, and the relative advantages and disadvantages of MRI as compared with other imaging modalities.

New generation MRI

Bloch BN, Furman-Haran E, Helbich TH, et al. Prostate Cancer: Accurate Determination of Extracapsular Extension in Prostate Cancer Using High Spatial Resolution Dynamic Contrast Enhanced and T2-W Magnetic Resonance Imaging – Initial Results. Radiology 2007;245:176-185. PMID: 17717328.

Bloch BN, Lenkinski RE, Helbich TH, et al. Prostate Postbrachytherapy Seed Distribution; Comparison of High-Resolution, Contrast-Enhanced, T1- and T2-Weighted Endorectal Magnetic Resonance Imaging Versus Computed Tomography: Initial Experience. International Journal of Radiation Oncology, Biology, Physics 2007;69,70-78. PMID: 17513062.

Bloch BN, Rofsky, NM, Baroni RH, et al. 3 Tesla Magnetic Resonance Imaging of the Prostate with Combined Phased-Array and Endorectal Coils; Initial Experience. Academic Radiology 2004;11:863–867. PMID: 15288036.

Mullerad M, Hricak H, Kuroiwa K, et al. Comparison of Endorectal Magnetic Resonance Imaging, Guided Prostate Biopsy and Digital Rectal Examination in the Preoperative Anatomical Localization of Prostate Cancer. Journal of Urology 2005;174:2158–63. PMID: 16280755.

Rosen Y, Bloch BN, Lenkinski RE, et al. 3T MR of the Prostate: Reducing Susceptibility Gradients by Inflating the Endorectal Coil with a Barium Sulfate Suspension. Magnetic Resonance in Medicine 2007;57:898–904. PMID: 17457870.

Sella T, Schwartz LH, Swindle PW, et al. Suspected Local Recurrence After Radical Prostatectomy: Endorectal Coil MR Imaging. Radiology 2004;231:379–85. PMID: 15064390.

Sosna J, Pedrosa I, DeWolf WC, et al. MR Imaging of the Prostate at 3 Tesla: Comparison of an External Phased-Array Coil to Imaging with an Endorectal Coil at 1.5 Tesla. Academic Radiology 2004;11:857–862. PMID: 15354305.

Yuen JS, Thng CH, Tan PH, et al. Endorectal Magnetic Resonance Imaging and Spectroscopy for the Detection of Tumor Foci in Men with Prior Negative Transrectal Ultrasound Prostate Biopsy. Journal of Urology 2004;171:1482–6. PMID: 15017203.

New options in MRI technology

MRIs can be done with or without an endorectal coil. What is the advantage or disadvantage of including an endorectal coil?

An endorectal coil in MRI functions a bit like a television antenna. It’s a thin wire, covered with a small inflated balloon and inserted into the rectum. Once the MRI device is turned on, the coil receives the magnetic waves, which we will analyze with a computer to gain information about the magnetic properties of a particular tissue. The closer the coil is to the target tissue, the stronger the signal. (The fundamentals of MRI technology are explained in “MRI basics“, below.)

The disadvantage of an endorectal coil is that it can be uncomfortable. Fortunately, most people are able to cope with this. We routinely inject a muscle relaxant to help muscles in the rectal wall relax a little and improve comfort. We can also offer some patients mild sedation, to ease anxiety.

What other new MRI technology is available, and why do you think it improves prostate cancer diagnosis and staging?

After Beth Israel Deaconess Medical Center purchased the 3T scanner with funding by a generous philanthropist, we produced very good images of the prostate gland using traditional coils placed on top of the body. But we had a great opportunity to improve the images even further since two of our colleagues at Beth Israel Deaconess Medical Center were among the researchers who developed the original endorectal coil while they were at the University of Pennsylvania — Dr. Robert Lenkinski, now vice chair of Radiology and director of Radiology Research at Beth Israel Deaconess Medical Center, and professor of radiology at Harvard Medical School, and Dr. Herbert Kressel, currently radiologist in chief at Beth Israel Deaconess Medical Center and the Miriam H. Stoneman Professor of Radiology at Harvard Medical School. I talked with them and suggested that we develop a coil specifically for use in a 3T scanner. We worked with a medical device company and developed an endorectal coil that is appropriate for the 3T scanner. When we looked at the first few images created using this new coil, we realized that this was going to be a game changer.

Why was that?

The combination of the more powerful scanner and endorectal coil, along with improvements in contrast-enhanced imaging, produced a degree of anatomic detail we hadn’t seen before.

The higher the strength of the magnet, the clearer the image?

That’s correct. One way to understand the importance of a higher tesla value is that a more powerful magnet creates a stronger signal, which we can use to construct a much higher spatial resolution in the image.

MRI basics

  • MRI uses the electromagnetic properties of hydrogen molecules to collect information about organs and other tissues and converts this to an image.
  • Cancerous tissue has a different set of magnetic properties than surrounding normal tissue. MRI is able to capture these differences.
  • Ionizing radiation, which is the type used to generate an x-ray or CT scan, carries some risk because too much exposure to this form of radiation can potentially damage a person’s genetic material. But MRI does not involve ionizing radiation, so there is no danger with single or repeat exposures.
  • An MRI exam takes 45 minutes to a little over an hour.
  • Before undergoing an MRI, your doctor will ask whether you have any electronic or metal medical devices in your body, such as a heart pacemaker or any metallic clips, pins, or screws. These precautions are necessary because the MRI magnet is so powerful that it could interfere with a pacemaker or displace some implanted clips.
  • An MRI magnet is measured in units of tesla (T), in honor of Nikola Tesla, a renowned physicist and electrical engineer who was very interested in magnetic fields. MRI magnets generally function between 0.5T and 3T. Most diagnostic work over the past few years has been at 1.5T.

Can you talk more about contrast-enhanced imaging, and how this has improved recently?

Radiologists can make an MRI image clearer by using contrast media, which have their own magnetic properties. That’s why some people receive an injection of a contrast medium, or what is sometimes called a “dye,” before undergoing an MRI. For a brief time, as the contrast material passes through tissues of interest, it will alter the magnetic properties of that tissue, depending on the amount and rate of absorption. And that gives us a great deal of information to characterize tissue.

The problem is that contrast enhancement is difficult to do because it requires that you collect images so rapidly that you lose some degree of spatial resolution in the process. But researchers in Europe and Israel have been collaborating on ways to solve this problem. While he was at the University of Vienna, Dr. B. Nicolas Bloch developed an improved approach to contrast-enhanced imaging of the prostate that provides better spatial resolution. He did initial work in collaboration with Dr. Hadassa Degani, a phenomenal researcher at the Weizmann Institute of Science, who was working with breast tissue. Dr. Bloch has since become a radiology clinician researcher at Beth Israel Deaconess Medical Center, where he’s perfected those techniques and is applying them to MRI imaging of the prostate using the 3T scanner.

Figure 1: Using contrast-enhanced 3T MRI to guide prostate biopsy

The patient whose prostate is pictured here had an elevated PSA, indicating that he might have prostate cancer. But several biopsies guided by traditional imaging technology came back negative, meaning they did not reveal cancer. The images below show why endorectal MRI with contrast enhancement can provide better guidance.

Using contrast-enhanced 3T MRI to guide prostate therapy

1A: This image was produced by a typical endorectal MRI with contrast enhancement. The MRI shows no suspicious areas or distinguishing features, which doctors use to guide a prostate biopsy. In such cases, the sampling is random — and in this patient’s case, missed the cancer.

1B: This image was taken from the same angle as Figure 1A, but used 3T endorectal MRI with contrast enhancement and a color-coding technique. The cancer shows up clearly in red (partly because of angiogenesis, the formation of multiple leaky blood vessels that feed a tumor). Normal blood vessels are shown as thin red lines near the rectum, and normal prostate tissue is seen in blue.

The yellow arrow points to an area in the anterior portion of the prostate, which is not normally sampled during random biopsy. When contrast-enhanced 3T MRI was used to guide the biopsy, doctors were able to sample the suspicious area, and found cancer — providing the patient and his doctors with crucial information to make treatment decisions.

So the images displayed in Figures 1 (above) and 2 (below) were produced by combining the new MRI technology with this improved contrast-enhancement technique?

Correct. And once again, working with researchers at the Weizmann Institute, we developed a color-coded technology where cancer shows up as red, and that really simplifies the evaluation. In traditional imaging, it’s possible to miss small clusters of cancer because the features are so subtle. But if you see it in red, it really jumps out at you.

Figure 2: Detecting cancer recurrence after radical prostatectomy

Detecting cancer recurrence after radical prostatectomy

In a typical ultrasound image, the prostatic bed (the area that remains after the prostate is removed) usually appears as a sea of gray. Because other tissues and organs shift position after prostatectomy, to fill up the space where the prostate was once located, the anatomical landmarks are hard to interpret with ultrasound. There are no distinguishing features that would suggest where the prostate used to be, or where a recurrence of malignant growth may be located. Without such guidance, the biopsy is likely to be negative, and it will not be clear whether the patient should be treated.

In a color-coded contrast-enhanced endorectal MRI shown above, the cancer shows up clearly as red, while normal tissue is blue and green. This MRI was used to direct a biopsy that sampled the cancer, providing guidance for treatment decisions.

Do you also use MR spectroscopy? If so, could you explain what that is?

MR spectroscopy provides a way to look at specific chemical properties within a particular tissue. And so we can actually get information about molecular structures and metabolites, providing us with much more detail about the prostate gland itself. We’re combining many MRI “looks” at the prostate, in order to obtain unique information and then use all that information together to formulate a clearer picture of what’s going on in an individual’s prostate gland.

And as a result you’re providing better diagnostic information?

By using high-resolution contrast-enhanced imaging, we believe that we are able to stage prostate cancers much better. We can give patients specific information about the extent of their disease. And certainly that will help men and their doctors make more informed treatment decisions.

What are the advantages and disadvantages of ultrasound imaging of the prostate gland, versus MRI?

The advantage of ultrasound is that it’s readily available and, from the hospital’s perspective, a less expensive technology to purchase. However, this technology has its limits. For example, when ultrasound is used to guide a prostate biopsy, it enables the doctor to locate the prostate gland for gross placement of the needle, but ultrasound provides no reliable information about where cancer might be. As a result, the biopsy consists of a random sample of areas within the prostate.

In MRI, especially with this new technology, we can actually show where cancer may exist within the prostate gland. That enables a doctor to do purposeful — rather than random — sampling of the prostate.

How accurate is this new MRI technology?

We did a study, now in press, with a side-by-side comparison of an MRI image and its corresponding pathology slide. So we basically tried to slice the gland in pathology exactly how we “sliced” the gland when it was in the patient. This is known as the “whole mount” technique for pathology. We orient the prostate during pathology, so that it matches the way the gland was oriented during imaging, and we slice it exactly the way the individual image slices were obtained in the MRI. In that way, we try to repeat what happened in the imaging session with the pathology specimens.

In our latest publication, we had an accuracy rate of 95%. So in other words, 95% of the time the stage that we predicted using MRI before surgery was confirmed afterward when the gland was sent to pathology. This is important because understaging occurs alarming regularity in prostate cancer. Nationally, as many as 40% to 50% of men initially thought to have early-stage cancer will find out later that they have more extensive disease – although this varies by institution.

Which patients might benefit

When is MRI recommended for men with prostate cancer?

Men who are most commonly referred to our center have had a prostate biopsy that reveals cancer, but some other aspect of the diagnostic workup raises questions about the extent or aggressiveness of the cancer. For instance, maybe the PSA level or biopsy indicates that cancer is aggressive, but nothing can be felt on a digital rectal exam. In this type of situation, an MRI can help to resolve the issue.

So you’re trying to provide some additional information that might affect a treatment decision?

Exactly.

What are some other situations where MRI is helpful?

One of the more useful applications of MRI is in locating cancer that has not shown up on a biopsy. This can be very helpful to a man who has not yet been diagnosed with prostate cancer despite having an elevated PSA and continued biopsies that come back as being “negative,” meaning there is no evidence of cancer. The urologist thinks that cancer is present, but can’t find it based upon the biopsy results. Often men are referred to us after they have several negative biopsies. We can use MRI to advise the urologist where to target the biopsy needle, so that the doctor samples the area where we have the highest degree of suspicion that cancer exists.

And we’ve learned that often those patients who have a PSA that continues to increase, and are thus suspected of having cancer, yet whose biopsies come back negative, have cancer in locations that are poorly sampled in a routine ultrasound-guided biopsy. Many tumors we detect are located in the anterior portion of the prostate, in front of the urethra, toward the pelvic bones. These cancers cannot be seen with ultrasound and are extremely hard to hit with a biopsy needle. Virtually the only way to identify and diagnose these tumors is with MRI.

Other cancers are found low down, at what is known as the apex of the gland, or very high up, in the base. We’re working in conjunction with urologists right now, to use MRI to improve our ability to find these elusive cancers.

How do you answer critics who have not kept up with developments in this field and remember MRI of the prostate as being no better than a coin flip, and who believe that this may be a total waste of time and energy?

I would answer them by saying that it’s a whole new world, with new technology, and new insights, and to close your patients off to this emerging technology is a great disservice. There are many new possibilities, and many of those will be in the published literature over the next year, as our data are published. So you’ve got to believe in the clever, creative, and dedicated people out there who can move the field forward.

When to consider a prostate MRI

Studies indicate that MRI may be helpful in the following situations. The best images are obtained when using an endorectal coil.

  • You have a PSA that continues to increase, but an ultrasound-guided prostate biopsy does not reveal cancer; an MRI may be able to better pinpoint a suspicious area for a more targeted biopsy and increase the likelihood of finding cancer if it is there.
  • Different elements of your diagnostic workup are in conflict (for instance, your PSA level is high, but your Gleason score is 3 plus 3 and cancer is found in only 1 of 12 biopsy specimens); an MRI can better determine size of the tumor and whether it has extended beyond the capsule.
  • For large palpable tumors, MRI can rule out cancer that extends beyond the prostate itself.
  • If your PSA rises following prostate cancer treatment, MRI can be used to identify any cancerous tissue in the periprostatic bed (the area in the pelvis where the prostate was once located), which indicates a local recurrence.
  • MRI may provide better guidance about where to target radiation therapy.

Additional uses under investigation

How might this technology be used in the future?

We’re working toward performing biopsies directly through MRI guidance, probably by superimposing MRI information onto an ultrasound image. In this way, we could maximize benefits of MRI in identifying areas to target during biopsy, to increase the chances that cancer is sampled.

Many men are undergoing active surveillance, which means that their cancer has been diagnosed, but they are monitoring its progression before undergoing treatment. Have you had any experience with whether MRI could help such men to monitor cancer progression?

That’s another area we’re studying. But we’ve already been following individual men, on a case-by-case basis, who are undergoing serial MRIs at Beth Israel Deaconess Medical Center because they are undergoing active surveillance. In some of those patients, we’ve actually seen the cancer grow in size.

We think that in the future MRI may offer an opportunity to follow these patients without asking them to undergo biopsies. Instead, MRI might be able to provide an objective measure of whether cancer is remaining dormant, or whether it’s growing. We are accumulating data on that. Of course, this is still at the research stage. But I believe that one day we’ll be able to use MRI to categorize some tumors as being very slow-growing, with a good option for active surveillance, while identifying others that may transition into aggressive cancer. And hopefully we’ll be able to identify those patients early, perhaps even before a PSA bump is detected.

Are there any differential MRI appearances according to the Gleason score of the prostate cancer, as finally determined by pathology?

We have preliminary data provided by MR spectroscopy that a particular chemical profile is related to the Gleason score. As part of our research, we hope to use MR spectroscopy to gauge aggressiveness of a tumor to add yet another dimension to information provided by the Gleason score. A Gleason score is helpful, but it provides just one way to measure tumor aggressiveness; there are times when men with low Gleason scores have aggressive tumors. So we hope to use MRI and MR spectroscopy to provide other ways to characterize a tumor.

For more information

If someone reading this interview decides he wants an MRI, but his hospital does not have the sophisticated equipment we’ve been discussing, what should he do?

Anyone is welcome to contact Beth Israel Deaconess Medical Center.* Many patients are referred to us for imaging, and then return to their own urologist. In those instances I do ask to speak to the referring urologist or medical oncologist or radiation oncologist, because I want to know how the information will be used and I want to ensure continued follow-up of patients who have undergone imaging at our center. However, I do encourage patients from other hospitals to see another member of our comprehensive team, so they can benefit from more than just our imaging expertise.

*Note: To find out if you should consider asking for a referral, see “When to consider a prostate MRI,” above.

What other hospitals have a comparable technology?

Our specific approach is pretty unique to us right now. In terms of 3T imaging systems that are performing endorectal prostate imaging, I’d be surprised if there are more than 20 in the world doing it in a meaningful fashion at the moment. But the systems are proliferating quickly.

Originally published March 2009; last reviewed April 7, 2011.

Comments:

  1. David

    You mention above further including spectroscopy (i.e., a parameter) to aid in prostate cancer visualization that uses the endorectal 3T MRI with contrast enhancement and the color coding technique. Do you do a multiparametric analysis?

  2. Ken Chapel

    Ken 62yo; psa 12 in 7/17 (put on two weeks of cipro because of bacteria in urine; psa dropped to 8; watch and wait, psa stayed 8.5 range next 4 months. doc ordered contrast mri; I researched contrast agent (gadolinium) and was concerned about the toxic metal deposits in brain and organs left behind. Imaging Lab told me they use ‘new improved version’….last thing tech told before entering mri machine that if I didn’t urinate within 7 hours following dye injection to go to emergency room…..I’m a big guy and my folded arms restricted my breathing and after 30 minutes in the tube and right before the injection of dye I worried about making it the last 10 minutes and the ‘go to emergency room if you don’t urinate’ got in my head; I didn’t want to have the risk of the dye with no benefit if I had to bail…..so, I bailed before dye injection. Will the images from this 3T mri provide enough detail to help in diagnosis?

  3. Michael

    My dr felt my prostate felt normal size felt no lesions . Had a MRI of my prostate they found 2 spots but they came back as significant cancer unlikely very confused. Now I need to schedule a biopsy

  4. John O'Meara

    I am 72. My father died at 92 with a PSA in the 80’s. In 2016, a PSA in May was 5 and a followup PSA in July was 11. Dr suggests an MRI which I did. Radiologist report on MRI leads my urologist to suggest a MRI directed biopsy. I go to Dr. Busch in Chattanooga who does the MRI but no biopsy because he sees nothing to biopsy. He shows me the 2 MRI’s. The one done locally looked like a black-and-white TV picture from the 1950’s while Dr. Busch’s MRI looks like color HD TV.

    In 2017, PSA in July at VA was 6.4. Went to see new urologist in September because I’m leaving the country for an extended period and the previous urologist retired. Despite having the PSA from July, they draw blood anyway. New PSA is 13+. Dr. says “you need a biopsy”. I say the test results are probably flawed and I ask for a repeat test which comes back with identical results (13+). Dr. says “you need a biopsy” to which I say I would rather go back to Dr. Busch in Chattanooga for an MRI and biopsy if needed. Trying to get an appointment as I type.

  5. Stan

    Does sawpalmetto daily taking skew the PSA?

  6. Dyke

    I a, 86 psa of 104,but came down to 40k after monthshad dRe and mri cannot find anything from dr.only that I have some lesions on outside of gland .how could that be ,maybe bi0psi e sever
    al years ago caused very
    Cece use it did get bad infection from the biopsi.now Watonga to see another uroligist. John dayton ohio

  7. david lynsh

    My doctor had me do an MRI with coil as well. PSA 5.2, normal DRE Free PSA 12. MRI with Coil shows BPH with no suspicious legions anywhere. Now wants to do biopsy anyway. Says he would “hate to miss anything”.

  8. Lawrence Scoles

    My doctor is having me do an MRI before a biopsy. I am 65 with PSA of 6.4. After the MRI I will have to decide what to do. This information is helpful but confusing at the same time. If the prevalence rate of cancer irrespective of the PSA is only 8 % as in the prior comment.. I am not sure if I want to do anything. Wish there were more of a consensus on what to do.

  9. Lawrence Yatsushiro

    June 20th at 7:23 PM (Hawaii time)
    Had a biopsy when my PSA reached 6.7 last year in June. One core had less than 3% sample with a Gleason Score of 3/3. Decided to go with watchful waiting after a visit at Loma Linda in Los Angeles. When my urologist recommended a follow up biopsy this year I decided not to as there was a lot of bleeding from the first biopsy and I am afraid of the biopsy spreading any cancer that exists. Had a MRI with contrast dye done and the results showed very little activity. Have decided to follow up and use MRI’s (annually) as my primary tracking procedure along with PSA test. Does this make sense?

  10. James e Williams

    I went to a Dr in 2014 to see if I had prostate issues.He had me do a biopsy.I got infected from exam and had to do treatment at my house for 14 days.Dr said he wanted to observe the cancer rather than do surgery.I was disgusted with him. I changed Dr and start going to another Dr. Now he want to do MRI fusion and ulter sound June 30.I have concerns.If I do the procedure should I be put to sleep and is exam necessary

  11. Byron

    MD with prostate carcinoma grade 3+3=6. MRI next for me. It’s watchful waiting unless we hit grade 7, then therapy. The PSA and the MRI are only indicators to get the best possible biopsies for the pathologist. If you don’t have prostate cancer, nobody can tell you that with 100% confidence.

  12. MS Sangwan

    I feel the PSA expanded to read “Prostate Specific Antigen” is hardly specific. Had it been so there would not be no such controversy over this antigen. Prostate starts growing in size from age of 25 but its effects are evident generally after the age of 45-50 years. I think one may not be over worried about it. One should go for surgery when symptoms adversely affect the Quality of Life. Urologist would definitely require a biopsy/MRI prior to surgery to rule out Cancer since the surgical treatment differs in each case. The prevalence rate of cancer is 8 % irrespective of the PSA level. The comment is based on review of literature available on the subject and my personal experience

  13. Jeff Jones

    For those who have had a negative biopsy, another tool is the PCA3 test or the MiPS test. I believe protocol is not to do the test until after a biopsy but that could be just due to insurance coverage, and you may be able to avoid a biopsy if the numbers on either of preceding tests come back low.

  14. Dan Weeden

    September 15, 2016

    Dan W

    I had a HIFU ablation procedure performed on October 14, 2013 in Cancun. Dr. Stephen Scionti oversaw the procedure. He was at that time the Training Director for International HIFU as well as the head urologist at one of the noted Boston Hospitals. Gleason grade 8 T1. Three follow up MRIs are negative including a 3T in December 2015 at Partners in Imaging, read by Dr. Richard Goldberg, located in Sarasota, Fla. An extensive Artemis biopsy performed by Dr. Scionti in December 2014 showed all biopsy samples to be negative. Dr. Scionti has opened his own business in Sarasota, Fla., The Scionti Prostate Center. Dr. Scionti is perhaps the most experienced DR. with the HIFU ablation procedure in the US. He is an expert at biopsy procedures. I was told what types of tissue in my prostate that he intended to biopsy and those were indeed listed on the pathology report–and all were benign. I had a lumbar injury in 2010. I was ex-rayed, I believe, 23 times in about 6 months to verify the progress of my recovery with water therapy and chiropractic care. I feel that this is what caused my cancer especially as the ex-ray equipment appeared to be an older generation, maybe from the 70’s. HIFU and MRIs seem to be the safest way for men to choose as treatment and to monitor their prostate health.

    • Thomas Ridley

      Highly interested in the hifu option in Sarasota with Dr. S. Have been investigating but not finding a lot of information because of the newness of the procedure and fact that it was only approved by the FDA in 2015. Would like the opportunity to speak with you. Site states email address not published. Would greatly appreciate speaking with you and perhaps we can coordinate through my email address, tomridley2@ yahoo.com. Thanks in advance.

  15. Stephen J Van Osdell

    Just saw this. I HIGHLY recommend Dr. Joseph Busch in Chattanooga. I just had him do an MRI on me on July 21st. My TRUS biopsy (only 60% accurate!) found 5 cores of GS 6. Dr. Busch’s MRI found a spot and biopsied JUST THAT SPOT and it was sure enough GS 7 (3+4)! Now, I’m talking to Dr. Eric Walser in Texas about doing Focal Laser Ablation to burn just that spot and save my prostate. For what its worth, my local urologist was recommended removal simply based on the 5 cores of Gleason 6! Talk about over treatment! All it would have taken was for me to say ‘let’s do it’. I learned of Dr. Busch and FLA from an entirely different source. If there is a men’s prostate support group in your area, get there fast as you can. That is where you will learn what works and what is risky. Tell Dr. Busch that Steve from Cincinnati recommended him to you.

  16. Jim

    Whats the point of these comments and questions if no one answers them?

  17. Vann H

    does anyone know anything about DR.JOSEPH BUSCH in Chattanooga TN and his 3tMRI procedure ???

  18. Greg O

    52 yo. PSA now 4.2 Free PSA % 15. DRE normal. Biopsy done 2014 PSA was 3.9 negative result. Still suffering from symptoms such as hemosperma. Had MRI recently. Image showed 6mm lesion. Radiologist rated PDI score of 2-3 meaning unlikely to eqivoul chance of cancer. Urologist sending me for another biopsy with the idea of targeting lesion. He still thinks just benign.

  19. Dr Brian K. Bailey

    My PSA went from a consistent (4.5 + or – 0.2) to 7.47 in 17 mos. I was treated with several antibiotics thinking it was prostatitis then it went to 9.89 in two mos. I postponed my next urologic appointment because I was scared it is probably prostate cancer. That is when I began my research. I was already eating healthful (I thought) and taking many vitamins and supplements. My urologist scheduled me for a prostate biopsy. I began adding nutrients to my program and continued to discover more to add. My PSA dropped to 6.3 in two mos. and to 4.2 in another mo. 3.64 in two more months. This was lower than it was six years ago. I cancelled my biopsy. Here is my program:
    NUTRIENTS FOR PROSTATE CANCER PREVENTION AND ERADICATION
    NATURAL NON-TOXIC CHEMOTHERAPY FOR PROSTATE CANCER
    Available at Amazon.com

    • Larry F

      Nice post Dr but to be honest it sounds like you’re just trying to sell your book. Why not list what you did to get your PSA lower. Do all of the men out here looking for answers a service, instead of making it sound like you’re trying to sell a book.

  20. Ernest Link

    I am a 50 y/o man who was tested for psa on 2/17/16 for the first time my level is 3.78, I have done extensive bicycle touring and raceing for the past 25yrs did not bicycle between June 2015 and Feb 2016, in Feb I biked 3times before the blood test, I wakeup 1-2 time at the end of sleep to urinate for the past 2 yrs and take no medications for urinary symptoms, PMHX of graves disease. what should my next step be to f/u screening for prostate CA?

    • Larry F

      As long as your PSA is below 4 you should not have to worry. Mine has been 3.68 3.78 3.5 in the past for many years since I was 40 years old. Of course a urologist becomes alarmed if its 2.0 or above. A regular general doctor goes by the guidelines of 0 – 4 being normal. As far as your bike riding is concerned you should not be riding your bike or having a digital rectal exam prior to having a blood test for PSA. I would give up the bike riding for at least a good month before you go in for a PSA test

      • robert

        I feel that’s how I got to this point was from bike riding never realized I was hurting the rest of my life .so very distrot totally devastated as to what I’m getting ready to go through! Age 44 for anyone going through this be tough and keep ur chin up and love ur wife a lot were gona need the support god speed to all luv u!

  21. Adam Scott

    I am 54 and my PSA tests continue to increase. It’s currently at 9 (8 six months ago). Just six months ago i had a negative MRI and 3 years ago a negative biopsy. I would prefer to do another MRI rather than a biopsy since the last time i did a biopsy i had some bad bleeding. Is an MRI as accurate as a biopsy in detecting cancer?

    • Larry F

      Not sure why nobody responds to any of these questions. I’m almost 57 have a 6.5 PSA. Supposed to go through biopsy cancel last appointment and probably will cancel the one scheduled in a few days. I don’t understand why the medical industry concerning prostrate don’t all get together and figure these scenarios out. I would think MRI with contrast and a coil and a 3T machine would be the first choice instead of poking and prodding blindly into the prostate risking infection sepsis and even possible death of a patient. Much of this must be based on insurance because I’m sure MRIs are not cheap. But neither is repeat doctor’s visits repeat biopsies repeat repeat repeat as men we are all lost as to what to do and anxiety steps in. Why don’t the powers that b see this, fix this. In this day and age is it really hard to detect prostate cancer? Is it really hard to figure out that if a man’s PSA is elevated we have to jump in and do a blind biopsy to me it’s like putting the tail on the Donkey. How can that benefit any patient? For me I think doctors should feel ashamed of themselves doing this type of method. We just want to know why are PSA is are elevated is it cancer or is it just normal for us or is something else driving the PSA up.

    • robert

      Do the the 3-t mri with the coil it sucks but it is as good as it gets in picture wise it’s not that bad

  22. Prof A J KANWAR

    I am 67.
    My PSA has been high since 5 years going upto 15
    Last January 2014 biopsy from 12 pieces was normal
    PSA still raied
    MRI normal
    Do I require a repeat biopsy?

  23. Mark Robinson

    7 months ago my psa was 8, and we did the standard biopsy. No cancer found (with 12 samples). We did the psa again 1 month ago, and it had gone up to 13.6. We then did the mri/ultrasound with coil and contrast dye, and the report came back with this scary summary:
    Impression
    1. Lesion within the base of the left peripheral zone, intermediate to high suspicion for malignancy.
    2. Ill-defined small lesion within the right base of the peripheral zone, intermediate suspicion for malignancy.
    3. Few subcentimeter pelvic lymph nodes are scattered throughout pelvis.

    So we just did another biopsy using and targeted the areas mentioned in the report (with 15 samples), and the report came back with absolutely no cancer found whatsoever.

    Next step is another psa test in 90 days. My current urologist can’t do anything else for me except to refer me to some specialists at USF Hospital in San Francisco. They have the equipment to do the ‘fusion’ mri/ultrasound that maps the image onto the prostate pic so that it’s easier to pinpoint something malignant. Any suggestions?

  24. Romeo Gador

    An external beam radiation was recommended, is it necessary to have MRI for staging prior to irradiation?
    Dx: Prostatic Adenocarcinoma Gleason 7 , 3+4. Left lobe
    Prostatic Adenocarcinoma. Gleason 6 (3+3) right lobe
    PSA 4.6, 0.6 free 14.8%

  25. Romeo Gador

    I was diagnosed with prostatic adenocarcinoma Gleason 3+4=7 left lobe positive +6/6 Gleason 3+3=6, right lobe +3/6 following an ultrasound guided needle biopsy. PSA gradually increasing to 4.6.
    I am 76 yrs old

  26. Robert Nixon

    I have a higher PSA test result of 5.9 and my urologist wants to do a prostate biopsy. I am looking for a doctor and facility to do the 3T MRI of the prostate, as a replacement for doing a biopsy. Same question as John Kerwin above.

  27. Crescent

    Was John Kerwin ever answered? I have the exact same question.

  28. John F Kerwin

    At 77 I requested a PSA.The number was 9.I am now facing a Biopsy and I am against that for many reasons {invasive}.I have read quite a bit about the latest MRI procedure and would take that exam over all others. Would it be possible to have such a test without first having a needle biopsy.I seen to think that would be much more effective but would the powers that be allow this idea and do you think the insurance would agree.To me a biopsy is on the dangerous side and can open the door to trouble. Thank You

  29. dr tejinder malek

    I feel that my oncos in toronto are doing me a dis-service when they have refused a repeat biopsy and/or a repeat MRI when the last MRI showed no visible lesion after having been diagnosed with a Gleeson 8 and PSA 7.5 PCA and after having been informed that I had a high grade PCA. No visible lesion was seen after one year of being on intermittent bicalutamide, diet changes and some life style changes and the PSA had gone down to less than one. Their ratoinale was that it would not chaNGE THE MANAGEMENT OF MY pca AND HENCE IT WAS NOT NECESSARY!!

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