As the second most common cancer affecting men worldwide, prostate cancer is a haunting reality for many men1. But it doesn’t have to be. Early detection significantly improves prognosis, and recent advances in medical imaging technology, like prostate MRI (magnetic resonance imaging), machine learning, and artificial intelligence, have made early detection more accessible than ever.
An MRI for prostate cancer is a powerful tool for screening. It may even help find lesions before symptoms arise2. In some cases, an MRI can take the place of more invasive studies like a biopsy.
Unlike computed tomography (CT scans) and X-rays, which use harmful ionizing radiation, an MRI machine uses magnetic fields and radio waves as a means to create detailed images of soft tissues. This makes it a safer choice for getting high-quality prostate imaging3.
The Prostate: Where Is It and What Does It Do?
Chances are you’re not thinking about your prostate every day. And you’re not alone if you don’t know much about this gland and its functions.
The prostate is part of the male reproductive system, located deep inside the pelvis, just below the bladder. Imagine a small donut-shaped organ that encircles the tubes carrying urine from the bladder and semen produced by the seminal vesicles4.
As the term “gland” suggests, the prostate also secretes a liquid that merges with semen in the ejaculatory duct. Within the liquid is an enzyme called prostate-specific antigen (PSA). PSA also offers important clues to your overall prostate health.
Prostate Cancer and Symptoms
When the cells in the prostate gland begin to grow uncontrollably, cancerous tumors may form. Many types of prostate cancer grow slowly and initially stay localized within the prostate gland5.
Depending on your age and the type of prostate cancer it is, you may not need surgery or intensive treatment. However, there are rare, more aggressive forms of prostate cancer that spread quickly. In either circumstance, catching it early is your best strategy5.
Early diagnosis of prostate cancer, when lesions are still confined to the prostate gland, offers a higher chance of successful treatment. Once cancer spreads outside the prostate gland, treatment becomes more difficult, and it can significantly affect a person's life expectancy5.
This is supported by information from the American Cancer Society, which discusses the fact that the 5-year survival rate of patients with localized prostate tumors is nearly 100 percent but drops to 38 percent when the tumor metastasizes and spreads to other locations despite intensive therapy6.
Metastasis (spreading) occurs when cancer cells break away from the primary tumor of origin and travel through the lymphatic or blood system to another location. In many cases, prostate symptoms only manifest after cancer has reached advanced stages, making prostate screening even more important7,8. When symptoms do occur, the following are the most common6,7,9:
- Losing weight without trying
- Blood in urine
- Traces of blood in semen
- Urinary incontinence, including incidences of dribbling
- Diminished urine flow
- Sexual dysfunction
- Pain in the back, hips, pelvis, or rectum
Non-Invasive Tests: PSA and the Gleason Test
If you’re over the age of 50, have a family history of prostate cancer, or are experiencing symptoms related to prostate dysfunction, your doctor may order a blood test to measure the amount of PSA circulating in your bloodstream. While healthy levels vary based on age and ethnicity, significantly elevated levels may raise concerns10.
A crucial part of understanding prostate cancer involves PSA levels and the Gleason Score. The PSA test measures the blood levels of PSA, a protein generated by the prostate gland's cells. Higher PSA levels could indicate prostate cancer10. On the other hand, Gleason grading determines the aggressiveness of prostate cancer11. A higher Gleason Score points towards a higher chance of the cancer spreading12.
What Is a Screening MRI?
In the past, if you had a positive PSA test or an abnormal rectal exam, the next step would be an invasive and painful tissue biopsy. The problem with this method is that it doesn’t target specific areas or known abnormalities. MRI scans can reveal areas of concern that may warrant further investigation and may also help to rule out suspicious but less clinically important findings, thus helping you avoid an invasive biopsy.
Screening refers to the process of identifying potential health disorders or diseases in people who do not have any symptoms. The goal of screening is to catch diseases at their earliest stages when they are more treatable.
In the case of prostate cancer, screening may involve a prostate MRI. MRI uses a magnetic field to create radio waves that are received, digitized, and displayed in real time. When there are tissue abnormalities, its composition changes, so the images reflect areas with abnormalities.
MRI images can reveal tiny changes in the prostate that suggest cancer, playing a pivotal role in early detection. Moreover, it can help discern whether cancer has extended beyond the prostate to help determine the most effective treatment strategy.
Catching prostate cancer early can lead to less aggressive treatment methods, such as active surveillance, radiation therapy, or minimally invasive surgery. These options may result in fewer side effects than their more aggressive counterparts, reinforcing the importance of regular prostate health screenings, including MRI.
What’s Involved in a Prostate MRI?
There’s no doubt that MRI technology is highly effective in detecting prostate cancer, as well as other conditions such as infections and benign prostatic hyperplasia (BPH)13.
BPH is a benign enlargement of the prostate that affects many older and middle-aged men and may negatively impact their quality of life.
MRIs are less invasive than a prostate biopsy and offer quicker results. Biopsy results can take several weeks before you can follow up, while MRI reports are often available within a week.
Regarding what it’s like inside an MRI, the machine itself is a large, tube-shaped device with a hollow core. You'll lie on a table that slides into the MRI machine during the procedure.
The radiology technician will take a series of images using powerful magnets and radio waves. Depending on the study area, the test may take between 20 minutes and one hour. Let your technician know if you have claustrophobia or have difficulty staying in one position for extended periods.
During the scan, you won't feel anything but might hear loud thumping or tapping noises from the machine. For a better experience, ask your technician about wearing earplugs. Some facilities offer specialized headphones that allow you to listen to your favorite music streaming service or YouTube channel.
Since MRI machines use large magnets, be sure to remove any metal, such as jewelry or piercings. Let your technologist know if you have tattoos, permanent makeup, medical or dental devices, embedded metal (shrapnel), or any implanted metal body modification14.
What’s an MRI Scan With IV Contrast Like?
When you have a prostate MRI with IV contrast, the process begins similarly to the non-contrast MRI. However, partway through the scan, the technologist or radiology nurse will administer the contrast agent via IV.
The contrast dye helps to enhance the quality of the images by highlighting certain tissues, and it's particularly useful in assessing blood vessels and detecting small tumors. After the injection, the scan will continue for another 20 to 30 minutes.
MRI contrast agents are gadolinium-based and generally considered safe. However, some people might have an allergic reaction to the dye, and in very rare cases, it can cause disease in people with kidney problems called nephrogenic systemic fibrosis15.
Hence, it's crucial to inform your healthcare provider if you have any kidney problems or allergies. If you have any concerns, reach out to your provider prior to your appointment.
The type of MRI scan (with or without contrast) will be determined based on the specific information your doctor needs. Not all prostate MRI scans will require the use of a contrast agent. In some cases, a multiparametric MRI (mpMRI), which uses different types of MRI sequences to create a high-quality picture of the prostate, is conducted.
What's a Multiparametric MRI (mpMRI)?
A multiparametric MRI (mpMRI) is a special type of scan that gives a detailed 3D picture of your prostate, which is better than a standard MRI scan16. It's done using a computer program that can combine different types of images, making it easier to spot signs of prostate cancer.
This type of MRI combines a traditional T2-weighted MRI with functional MRI techniques like diffusion-weighted MRI (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI). According to a 2019 article in the Journal of the American Medical Association (JAMA), this type of MRI can reduce the need for biopsies17.
The Role of AI in Streamlining Prostate MRI Analysis
The images generated from your prostate MRI are complex and nuanced — and it can be a time-consuming process to interpret the images and spot abnormalities. This is where AI comes in.
Some facilities use cutting-edge AI technology to assist the radiologist by quickly analyzing your MRI scans. The use of AI and machine learning in the field of radiology for advanced feature analysis is an emerging area of imaging science called radiomics18.
It’s important to understand that while AI can assist in the interpretation of MRI data, the ultimate responsibility still falls to the radiologist. AI simplifies the workflow through automation. This makes the radiologist a bit more efficient and allows them to focus their attention on areas the AI algorithm brought to their attention. AI is a tool that saves time and may increase accuracy, but it doesn’t replace a radiologist’s expert diagnostic skills.
When and How Often Should I Book a Prostate Screening?
The United States Preventive Services Task Force (USPSTF) makes evidence-based recommendations for prostate cancer screening that aim to avoid overdiagnosis and overtreatment, including19:
- Men aged 55 to 69 should decide whether to be screened for prostate cancer after discussing the potential benefits and risks with their doctor.
- Men aged 70 and older should not be screened for prostate cancer routinely.
Patients deemed moderate to high-risk may need to be screened earlier or more regularly. Groups considered to have higher risk factors may include:
- African-American and Caribbean men of African ancestry have higher risk factors as they’re more likely to get an advanced-stage prostate cancer diagnosis; they’re also more than twice as likely to die from it than white men20.
- Men who eat a lot of red meat or high-fat dairy products and not enough fruits and vegetables appear to have a slightly higher chance of getting prostate cancer, according to a UK 2022 study21.
- Obese men diagnosed with prostate cancer could be more likely to have advanced diseases that are harder to treat. Recent studies suggest that there might be a link between obesity and prostate cancer22.
- Men with certain inherited gene changes have a higher risk of prostate cancer. A small number of prostate cancers are linked to inherited mutations in certain genes, such as BRCA1 and BRCA223.
Remember, these are general guidelines. If you have any of the risk factors listed, ask your medical provider how often you should have an MRI of the prostate or other screening.
Don’t know where to start? A prostate cancer risk calculator may help make sense of your prostate cancer risk.
What Happens Next if an MRI Is Abnormal?
While every case is different, your doctor may want you to see a urologist specializing in male reproductive health. It’s possible that you’ll need to undergo a prostate biopsy to take tissue samples from your prostate.
There are multiple types or approaches to prostate biopsies, including24:
- Transrectal Ultrasound Guided Biopsy (TRUS-GB): This technique involves inserting a small ultrasound probe into the rectum to examine the prostate gland. Using the ultrasound image, the doctor guides the biopsy needle and collects small samples of prostate tissue.
- Transperineal Biopsy: Here, the needle is inserted through the perineum (the skin between the scrotum and anus). It allows for the sampling of different areas of the prostate25.
- MRI Targeted Biopsy: For this method, an MRI scan helps to identify potentially cancerous areas. By guiding the biopsy needle toward the specific region, MRI exams improve accuracy24.
- MRI/TRUS Fusion Biopsy: This type of biopsy fuses previous MRI image data over real-time ultrasound images to guide the biopsy for greater accuracy26. This technique is especially useful for patients who’ve never had a prostate biopsy.
How Is Prostate Cancer Treated?
The goal of prostate cancer treatment is remission, but this is not always possible. In some cases, the focus is to prevent it from spreading into lymph nodes and surrounding tissue. The treatment plan for clinically significant prostate cancer is individualized and will vary depending on the patient's specific circumstances.
Once cancer is confirmed and staged, an oncologist — a doctor who specializes in cancer treatment — will discuss treatment options. A radical prostatectomy removes the entire prostate gland and some of the surrounding tissue. Other cancer treatments may include immunotherapy, chemotherapy, radiation, and hormone therapy5.
In cases of low-risk prostate cancer, active surveillance or "watchful waiting" might be recommended27. This approach involves monitoring the cancer closely and initiating treatment only if the cancer shows signs of progressing. The image quality of a prostate MRI plays a critical role in this process, enabling any changes in the cancer to be detected promptly.
MRI + AI for Prostate Cancer Screening Saves Lives
Ezra’s prostate AI technology, known as Plexo, has been cleared by the U.S. Food and Drug Administration for use in interpreting prostate MRI scans. Plexo uses algorithms trained on large datasets of prostate MRIs to help ]highlight areas that can be of concern.
Ezra’s technology can create a detailed 3D model of the prostate to aid in the identification of potential issues. If something suspicious is found, Ezra's team of radiologists will analyze the results further and recommend the next steps.
Prostate cancer is a formidable adversary, but with early detection and modern medical strategies, it’s an adversary that can be overcome. Knowing the risk factors and understanding the crucial role of advanced screening tools like prostate MRIs is a game-changer. Technology has the capacity to reveal the smallest changes that may cause cancer earlier.
While these technological developments are monumental in the early detection of prostate cancer, remember that it’s a collective effort. Regular check-ups, living a healthy lifestyle, and keeping an open line of communication with your healthcare provider are equally important.
If you’re health conscious and care to stay ahead of the curve, consider Ezra’s prostate cancer screening scan. It includes a non-invasive MRI scan that takes less than an hour. The scan is designed to identify any abnormalities or potential tumors in the prostate gland.
Taking care of yourself has never been easier. Book your appointment for a prostate MRI online today.
