MRI Scan for Prostate Cancer

What is an MRI scan?

Magnetic Resonance Imaging (MRI) scans use strong magnets to create detailed digital images of your prostate and surrounding soft tissues. When looking for prostate cancer and the likelihood of it spreading, consultants typically use MRI scans to avoid invasive procedures such as biopsies. It should be noted that if the scan shows the prostate cancer has spread a biopsy may subsequently be required.

What does an MRI scan involve?

MRI scans require the removal of all metal factors including jewelry, zips and buttons; internal implants such as metal plating or pacemakers could make MRI scanning impossible. Initial discussions about a patient’s general health will account for such factors, as well as other conditions such as claustrophobia are known to impact on the MRI procedure.

MRI Scan of the Prostate
Credit: Getty Images Ltd.

To clarify scan images, a small amount of dye may be injected into the patient’s bloodstream; those who are pregnant or suffering from allergies, asthma or kidney related illness should include this information in the questionnaire provided. Patients may be required to drink a large amount of water and to lie still on a table until the scan is complete, usually around forty minutes or less.

Why should I have an MRI scan?

Consultants usually identify prostate cancer and measure it’s growth rate using MRI scans although non-problematic cancers are typically found using biopsy. Whenever biopsies detect prostate cancer MRI scans can be used retrospectively and facilitate quicker patient treatment planning and to clarify if and where further biopsy should be taken.

In-depth studies on MRI scanning and the powerful magnetic fields involved have shown no risks to patients, making the procedure one of the safest stages of treatment available. Ongoing global research and development is already producing breakthrough technologies with scanners that can accommodate a patient’s medical condition or limitation.

Patients can often be accompanied by a close friend or family member throughout their MRI scan; listening to music via headphones for the duration is also a popular option. It’s important to remember that the MRI procedure is physically painless and any mild discomfort that’s experienced during the scan is short-lived and gone the same day.

Why shouldn’t I have the assessment?

The MRI procedure is loud and noisy; mild side effects include feeling warm, queasy, skin rashes, headaches and dizziness. Despite these factors, patients are usually allowed to return home on the same day and resume their usual activities; Note that this is impacted if patients have undergone sedation during their scan.

Patients can discuss sedation with their doctors far ahead of their scan date. Patients who have had a sedative (usually but not exclusively age or anxiety specific) will need to be accompanied for 24 hours following their scan and should avoid driving or operating heavy machinery.

Patients with metal implants or similar may require an initial X-ray. Patients with metal plates, artificial joints, pacemakers, nerve stimulators, dental bridges, surgical wires, medical screws or rods,  prosthetic heart valves, some tattoo inks, intrauterine devices, implantable cardioverter-defibrillators, penile implants, eye, cochlear or drug pump implants, tubal ligation or brain aneurysm clips may be precluded.

The results

A radiologist will assess MRI scan images to diagnose prostate cancer, before scoring each image of the prostate, using a scale ranging from 1-5; this is commonly referred to as either the Likert or PI-RADS (Prostate Imaging – Reporting and Data System) score¹.

Given scores dictate how likely a patient is to have prostate cancer and use this score when planning treatment.

A Likert or PI-RADS score of 1-2 means prostate cancer is unlikely and that if prostate cancer is detectedit may not require immediate treatment and regular PSA testing is usually advised to identify early changes in PSA levels.

The requirement to treat any urinary symptoms will also be assessed and offered to patients, as appropriate.

When considering a prostate biopsy to check for cancer, borderline Likert or PI-RADS scores of 3 means consultants must assess with other test results. Should a biopsy be deemed unnecessary regular PSA testing will be advised to identify early changes in a patient’s PSA levels.

A Likert or PI-RADS score of 4-5 indicates the probability of prostate cancer that demands treatment, as well as the need for a prostate biopsy. Where applicable, MRI scans can accurately identify and locate cancer cells ahead of the biopsy; this minimises prostate trauma from initial biopsy procedures and provides clarity for the treatment team.

Radiologists need to study and interpret your images, sometimes alongside colleagues, your results won’t be available on the day; these are usually sent to your doctor (within a fortnight or so) for further patient consultation. Patients should always consult with their doctor, to have any questions answered and their anxiety relieved.

¹Prostate Cancer UK, MRI scan for testing Prostate Cancer, January 2019

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