Study: MRI Missed 1 in 6 High-Grade Prostate Cancers

Study: MRI Missed 1 in 6 High-Grade Prostate Cancers.

The much ballyhooed multiparametric (mp) MRI does not appear to be suited as stand-alone test for diagnosing prostate cancer after an elevated PSA, according to new research.

The expensive and powerful technology failed to identify 16% of men with high-grade cancer (Gleason score ≥7) in a prospective study of 1044 men with an elevated PSA.

This study looked at patients who had negative MRI searching for prostate cancer. It found that the MRI missed almost half of all prostate cancers, but more importantly, missed 1 in 6 moderately aggressive cancers which are the ones that most need treatment.

I have been using MRI as a tool to help stratify the risk of prostate cancer, but I do not rely solely on the MRI results.

Mist worrisome to me is that at some place, radiologists are the only specialists trying to diagnose prostate cancer.

In my opinion, MRIs are useful, as our are radiology colleagues in helping to read the MRIs, but this should be done with the leadership of a urologist.

PCA3 Test Okayed to Help Decide Need for Repeat Prostate Biopsy – Renal and Urology News

“Over-expression of the PCA3 gene is highly specific to cancerous prostate tissue,” John Wei, MD, MS, Professor of Urology at the University of Michigan Health System in Ann Arbor, said in a company-issued statement. “When evaluated with other risk factors, the PROGENSA PCA3 assay fills an important unmet clinical need by helping physicians identify which men suspected of having prostate cancer should undergo a repeat prostate biopsy.”

via PCA3 Test Okayed to Help Decide Need for Repeat Prostate Biopsy – Renal and Urology News.


I’ve been using the PCA-3 test for a few years.  I have used it for this indication, as well as for patients who opt for active surveillance for their prostate cancer.  I am glad the test was approved for this use by the FDA.

Telling someone they have prostate cancer

One of the most difficult things that a urologist has to do is to tell his patient that he has cancer. I recently had a somewhat heated debate with my partner in robotic surgery.
Prostate cancer is the leading solid organ cancer in men and is diagnosed by a biopsy in the office. The reasons for a biopsy are given by the urologist when scheduling the procedure and the urologist is present for the biopsy.
I have had discussions with my partners about the two main ways of doing this for prostate cancer and there is a difference in opinion. The two ways are over the phone or face to face.

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