Multiparametric MRI for Prostate Cancer Diagnosis

Panelists: David Albala, MD, Crouse Hospital; E. David Crawford, MD, University of Colorado ; Raoul S. Concepcion, MD, Urology Associates, PC; Vahan Kassabian, MD, Georgia Urology; Steven E. Finkelstein, MD, 21st Century Oncology; Stephen J. Freedland, MD, Duke; and David I. Quinn, MD, USC
Published Online: Friday, January 17, 2014
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There have been several changes to the methods used to diagnose prostate cancer in the past two decades, moderator Raoul S. Concepcion, MD, says. In the 90’s, digital rectal exam (DRE) generally led straight to a biopsy, since PSA was not an option. Now, in addition to DRE and PSA, transrectal ultrasounds (TRUS) are utilized to guide biopsy and calculate PSA density.

Outside of these approaches, the use of multiparametric MRI for prostate cancer diagnosis has gained support in recent years. In general, David Albala, MD, states that MRIs are 75% to 80% sensitive at detecting prostate cancer. Additionally, MRI effectively picks up extra prostatic extensions and seminal vesicle involvement. Diagnosis in prostate cancer is beginning to lean toward a multimodal approach. However, the costs associated with these new imaging techniques can be significant, Albala notes.

As this approach gains acceptance, a great deal of work will need to be done to fine tune techniques, states Stephen J. Freedland, MD. This initial legwork should be considered before adopting the approach.

One of the challenges facing the widespread use of MRI is the lack of standardization, Albala believes. Using current methods, a clearly defined standard for low-, intermediate, and high-risk has been established for categorizing patients. However, these same standards do not exist for MRI and other imaging modalities.

In general, multiparametric MRI provides a useful tool for examining the prostate, although this approach may not be applicable for every patient, notes David I. Quinn, MD. Despite its clear usefulness, there is still work that needs to be done in order to make it a practical imaging technique, Concepcion states.
View More From This Discussion
Episode 1 Introduction: The AUA PSA Screening Guidelines
Episode 2 Melbourne Consensus Statement on PSA Screening
Episode 3 Case Study: Prostate Cancer Screening
Episode 4 Multiparametric MRI for Prostate Cancer Diagnosis
Episode 5 3D Transperineal Prostate Mapping Biopsies
Episode 6 Treating High-Risk Localized Prostate Cancer
Episode 7 Optimizing ADT in High-Risk Prostate Cancer
Episode 8 LHRH Agonists Versus Antagonists in Prostate Cancer
Episode 9 Intermittent Versus Continuous ADT in Prostate Cancer
Episode 10 Preventing Skeletal-Related Events in Prostate Cancer
Episode 11 Prechemotherapy Treatment Strategies in CRPC
Episode 12 Early Detection of Metastatic Prostate Cancer
Episode 13 Radium-223 in CRPC With Bone Metastases
Episode 14 Multidisciplinary Prostate Cancer Care
Episode 15 AR-Targeted Therapies in Advanced Prostate Cancer
Expert Panelists
Raoul Concepcion Moderator

Raoul S. Concepcion, MD

Urologists in Cancer Care, Director of Clinical Research
Urologic Surgeon
Urology Associates, PC
Nashville, TN

David Albala, MD

Medical Director,
Associated Medical Professionals; Chief of Urology, Crouse Hospital
Syracuse, New York

E. David Crawford, MD

Professor, Surgery and Radiation Oncology, Head, Urologic Oncology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado

Steven E. Finkelstein, MD

National Director, 21st Century Oncology, TRC
Scottsdale, Arizona

Stephen J. Freedland, MD

Associate Professor of Surgery, Associate Professor in Pathology, Duke University School of Medicine, Durham, North Carolina

Vahan Kassabian, MD

Medical Director
Georgia Urology
Atlanta, Georgia

David I. Quinn, MD, PhD

Associate Professor of Medicine, Medical Director, University of Southern California Norris Cancer Hospital, Los Angeles, California

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