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

March 10, 2009
  • By Harvard Prostate Knowledge


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June 18, 2018

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?

Ken Chapel
February 28, 2018

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…, I bailed before dye injection. Will the images from this 3T mri provide enough detail to help in diagnosis?

November 25, 2017

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

John O'Meara
September 24, 2017

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.

September 1, 2017

Does sawpalmetto daily taking skew the PSA?

July 21, 2017

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 Watonga to see another uroligist. John dayton ohio

david lynsh
July 10, 2017

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”.

Lawrence Scoles
June 25, 2017

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.

Lawrence Yatsushiro
June 21, 2017

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?

James e Williams
June 20, 2017

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

May 8, 2017

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.

MS Sangwan
March 19, 2017

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

Jeff Jones
February 2, 2017

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.

Dan Weeden
September 15, 2016

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
December 29, 2017

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@ Thanks in advance.

Stephen J Van Osdell
August 24, 2016

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.

August 13, 2016

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

Vann H
June 8, 2016

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

Greg O
May 11, 2016

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.

Dr Brian K. Bailey
March 31, 2016

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:
Available at

Larry F
April 19, 2016

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.

Ernest Link
February 24, 2016

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
April 19, 2016

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

Adam Scott
February 1, 2016

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
April 19, 2016

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.

May 3, 2016

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

April 19, 2015

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?

Mark Robinson
January 12, 2015

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:
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?

Romeo Gador
August 26, 2014

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%

Romeo Gador
August 26, 2014

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

Robert Nixon
July 26, 2014

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.

July 22, 2014

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

John F Kerwin
May 15, 2014

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

dr tejinder malek
November 7, 2013

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!!

May 3, 2016

Exactly what changes did u do any help would be very appreciated please

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