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Indications for prostate MRI:
MRI of the prostate is an evolving imaging process for detecting carcinoma of the prostate. Its most common use follows the diagnosis of prostate cancer (usually with transrectal ultrasound guided biopsies), where it is particularly useful for local staging and localisation of prostatic tumours. Prostate MRI can help distinguish between organ confined tumours (stage T1 or T2) and early advanced disease with local invasion (stage T3).
Patients are generally under the care of a urologist. Usually patients have an abnormal digital rectal examination, and an elevated or rising PSA and positive prostatic biopsies as an indication for the test.
Major contrast reactions (anaphylaxis) are very rare (roughly 1 in 10,000).
There is a very small risk of rectal perforation if an endorectal coil is used for the scan.
There is no specific post-procedural care required after a prostate MRI
Ultrasound has a low sensitivity for diagnosing prostate cancer and is used for guidance of biopsies only. Contrast-enhanced ultrasound is showing promise, but at the time of writing is still unproven.
If a patient is unable to have an MRI (such as those with pacemakers), then staging is carried out using a combination of computed tomography (CT) and bone scan.
CT scanning is used in the staging of prostate cancer to identify distal/metastatic disease. A nuclear medicine bone scan is used to show bony metastases.
If the MRI shows abnormal areas, a biopsy (or a repeat biopsy) might be indicated. Normally this is done using ultrasound with the operator estimating as accurately as possible from the MRI images where in the gland the biopsy should be directed. Two recent advances have increased the accuracy of biopsies after an MRI scan:
Neither of these techniques is, at the time of writing, widely available in Australia.
Page last modified on 26/7/2017.
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