Please tell us what you consider a quality MRI of the prostate.
That’s a very important question. There’s a wide variety of methods on how MRI is done. The single most important thing at an individual center is to have a meaningful discussion with the radiology team and a radiologist who has a specific interest in developing a prostate MRI program so they can gain experience and expertise. As you and the readers know, there are 1.5 Tesla magnets, 3 Tesla magnets, endorectal coils, and body phased array coils.
In general, most of the data suggest a 3 Tesla magnet with an endorectal coil gives the best pictures and the most accurate information. However, not every center has a 3 Tesla magnet, and a lot of centers do without the endorectal coil for patient comfort and workflow. You have to decide at your center what is best for your patient population, knowing that you may not have the highest level magnet. We tend to use endorectal coils because our best prostate radiologist swears by them and believes they provide higher quality pictures. Patients are forewarned that the endorectal coil will be used.
Do you do these in a radiology suite or in the urology suite?
All of the MRIs are conducted in the radiology suite. The prostate biopsies are done in the urology clinic.
Where do you see the value of MRI of the prostate?
Undeniably, the load of research suggests MRI images provide additional information for specific men at risk for prostate cancer or already diagnosed with prostate cancer. But I think it’s critically important for patients and urologists to realize that MRI is not perfect and will give false-negative and false-positive results. We can’t take the MRI information as gospel in every patient. It’s a guide for identifying potential cancers, where extra samples from certain areas may help us make smart decisions.