• Pamela Froman

Prostate MRI

National Prostate Health Month takes place this September and is the perfect time for men to get tested for this insidious disease.

Prostate MRI is the best technique for detection. MRI imaging techniques allow for increased sensitivity and specificity for cancer discovery. Dr. Robert Princenthal has established RadNet Prostrate MRI Program – one of the most robust practices in the nation.

Guidelines suggest men should get checked around the age of 50. The checkup should consist of a physical exam and a PSA (Prostate-Specific Antigen) which measures a hormone expressed by the prostate gland.

However there are issues with PSA. “The challenge with PSA testing is that in many men it can be elevated due to a benign condition and in about 10 to 15% of men with cancer their PSA doesn't go up,” says Dr. Princenthal. “It's sensitive but not specific.”

Previously when doctors ordered a PSA the standard management for treatment was to get a biopsy – and many men were getting biopsies that didn't need it. There has been a revolution in the ability for better screening for prostate cancer and that involves Prostate MR. Prostate MR makes screening more effective.

Prostate MR uses magnet waves and radio waves along with a small injection of an MR contrast agent to detect prostate cancer. The doctor gets highly detailed anatomic and functional imaging to find out if the man has tumors or suspicious nodules or if the gland looks benign.

The best thing that men can do to reduce the harms of prostate cancer detection and treatment, is to be smart and do their own research. “I think men need to take a page from women and learn how to fight for themselves,” says Dr. Princenthal. “There's so much misinformation out there that a lot of men feel that they are more afraid of the treatment than the disease itself. That leads to men being reluctant to get screened.”

One of the biggest fears for treating prostate cancer surgery is side effects of impotence and incontinence. But with improved detection with Prostate MR and surgical methods these dreaded side effects are really a thing of the past.

“With prostate cancer some men don't have to do anything to treat it but watch it,” says Dr. Princenthal. “But certain aggressive subtypes of prostate cancer can be lethal. Our job is to try and identify men at high risk, with radiogenomics and biomarkers, and tailor treatment protocols to their specific risk profiles.

The problem with prostate cancer is that many times there are no symptoms. Prostate cancer also increases with age. As men get older their prostate gland gets bigger and has symptoms of BPH or Benign Prostate Hyperplasia which makes it hard for them to empty their bladder. Prostate cancer when advanced can present with similar symptoms, so there is an overlap. The only way to identify the situation is with a physical exam, the PSA blood test and imaging or a biopsy.

There's more treatment options now than ever before with a revolution to individualize and optimize treatment for each particular man's type of cancer. Genetic testing of the tumors can provide useful information, and triage men into active surveillance, or watchful waiting, vs other men at risk, who would benefit from radiation therapy and hormone blockade, or surgery or focal therapy.

The number of men diagnosed with prostate cancer is roughly 200,000 per year and the death rate is 30,000. This almost identical to breast cancer in women. And just like with breast cancer, men can have a genetic risk factor, if their family member has the BRCA gene. Future treatment developments include a new nuclear medicine scan to help identify those men who have a disease that has spread from the capsule of the gland – this will have a big impact on treatment options. It's a growing world of PSMA PET imaging.

“With prostate cancer we are really increasing awareness and trying to optimize treatments,” says Dr. Princenthal. “We're trying to minimize the side effects and are encouraging men not to be afraid and to speak to their doctors and get tested.” Screening for prostate cancer with MRI imaging has been proven to be a cost effective strategy, reducing harms, and improving positive diagnostic yields.

For more information Dr. Princenthal and the RadNet Prostrate MRI Program log onto

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