The Importance of Prostate MRI: A Message from Radiology Associates

September marks National Prostate Cancer Awareness Month, a time dedicated to shedding light on a disease that, while treatable, can have devastating consequences if not caught early. Our mission at Radiology Associates is clear: to provide accurate and timely diagnostics using state-of-the-art technology, all while treating our patients with the utmost respect and care.

Prostate cancer is the most diagnosed non-skin cancer in American men. Statistically, 1 in 9 men will be diagnosed with prostate cancer during his lifetime. While these statistics may seem alarming, they also underscore the importance of early detection and intervention. The good news is that if detected early, the 5-year relative survival rate for prostate cancer is nearly 100%.

Now, you may ask, "Why Prostate MRI?"

Magnetic Resonance Imaging (MRI) of the prostate is a non-invasive imaging technique that has revolutionized our ability to visualize, detect, and grade prostate tumors. Unlike other screening modalities, MRI offers detailed images of the prostate gland, allowing radiologists to identify lesions that might be cancerous with greater precision.

Our team at Radiology Associates is proud to share that we complete thousands of Prostate MRI exams yearly, making us one of the highest volume centers in Florida. What sets us apart is our select group of radiologists who have undergone specialized training in prostate imaging. We provide our patients and their physicians the best possible information for treatment decisions.

So, who should consider a Prostate MRI?

1.            Men with elevated PSA levels: Prostate-specific antigen (PSA) is a protein produced by the prostate gland. Elevated PSA levels may indicate the presence of prostate cancer. An MRI can help confirm or rule out its presence.

2.            Men with a family history: If you have a close family member – father, brother, or son – who has had prostate cancer, your risk is significantly higher.

3.            Men of African descent: African-American men are more likely to develop prostate cancer and are twice as likely to die from it compared to Caucasian men.

4.            Men aged 55-69: The American Urological Association recommends shared decision-making for men aged 55-69 considering PSA-based screening. If PSA levels are elevated, an MRI could be the next logical step.

5.            Men who've had a previous negative biopsy but still have rising PSA levels: This is critical as traditional biopsies can sometimes miss cancer. An MRI can offer a more comprehensive look at the prostate.

Radiology Associates takes pride in being at the forefront of diagnostic imaging. But beyond technology and expertise, we are deeply committed to patient care. This September, as we shine a light on prostate cancer awareness, we urge every man to prioritize his health.

Early detection is the best weapon against prostate cancer. Let's make the choice to stay informed and proactive. Your health and future are worth it.

CT Colonography Screening for Early Detection of Colorectal Cancer

BACKGROUND

Colorectal cancer (CRC) is a type of cancer that originates in either the large intestine (colon) or the rectum. CRC is the 3rd most commonly diagnosed cancer in the United States, but one of the most treatable. Early detection is key to treatment, as there is a high chance of prevention by removing premalignant polyps and a possible cure if the cancer is confined to the colon.

According to a 2023 report by the American Cancer Society, there are 106,970 new cases of colon cancer and 46,050 new cases of rectal cancer in the United States each year. Individuals over 50 years old are at the highest risk of developing colorectal cancer (CRC). On average, women are diagnosed with CRC at the age of 75, while men are diagnosed at the age of 72. 

However, there has been a recent rise in CRC cases in people under 50 years old, representing 11% of colon cancer cases and 15% of rectal cancer cases. This has prompted both the American Cancer Society and the United States Preventative Services Task Force (USPSTF) to recommend that routine screening for CRC begin at age 45 for all adults. 

When caught early, colorectal cancer can be treated with a higher likelihood of success. Unfortunately, many cases of colon cancer are asymptomatic and go undetected until they reach a later stage. Around 60% to 70% of cases in symptomatic patients are diagnosed at an advanced stage, making them much harder to treat.

For this reason, several methods of CRC screening have been developed that are able to detect early-stage tumors while they are still highly treatable. Some of these methods include:

Colonoscopy: a thin, flexible endoscope is inserted into the rectum while the patient is under a type of anesthesia called conscious sedation. The entire colon is inspected for polyps: if a polyp is found, it can be biopsied or removed immediately.

Sigmoidoscopy: similar to a colonoscopy, a sigmoidoscope is used to inspect the rectum and only part of the colon. Not commonly used in the United States.

Stool Tests: tumors in the colon often release tiny amounts of blood and/or abnormal DNA into the fecal matter. A stool sample can be tested for these abnormalities. These tests are more expensive than CTC and have a much higher false positive rate.

CT Colonography: a radiologic imaging technology, computed tomography (aka “CT”) can be used to generate a detailed 3D digital image of the colon and the abdomen. This image can be examined by trained radiologists to detect suspicious polyps. This method does not require IV contrast or IV medications.

Screening for Colorectal Cancer

Traditionally, colonoscopy has been the mainstay of screening for colorectal cancer. Although colonoscopy is a sensitive screening test with the ability to detect very small polyps, it is also an invasive test that requires anesthesia and a downtime/recovery period of up to a week.

More recently, a technique called CT colonography (also known as “virtual colonoscopy”) has been developed as a less invasive method of CRC screening. CT colonography (CTC), is a radiographic imaging technique that uses X-rays and computer algorithms to create detailed 3D digital images of the air-filled colon and rectum. Per the findings of a 2007 study, it has been determined that CT colonoscopy is on par with traditional colonoscopy when it comes to detecting polyps greater than 1cm in size.

CT colonscopy does not require IV contrast, IV medications, or anesthesia, and you are able to drive yourself to and from your screening appointment. 

You may be referred by your doctor for CT colonography if you:

Are 45 years of age (or older) and at average risk for colorectal cancer (no personal or family history of either CRC or other abnormal polyps) 

• Are unable to undergo traditional colonoscopy (i.e., due to technical difficulty, the procedure is contraindicated, or if you are unable to tolerate the procedure) 

There are certain patients for whom CT colonography is not recommended. This may apply to you if you have:

• A personal history of previous adenomas or other suspicious polyps (as these may require a biopsy for surveillance)

• Active inflammatory bowel disease (active inflammation may interfere with the identification of CRC on imaging)

• Family history of CRC (traditional colonoscopy is generally preferred if you are at above-average risk) 

The bowel preparation for CT colonography is very similar to that required for traditional colonoscopy. As described in this article, preparation to cleanse the colon begins the evening before the appointment. A combination of laxative pills and liquid laxatives must be consumed, prompting several trips to the restroom. Although this process may seem like a chore, it is an extremely important step that enables the ability to obtain accurate, high-quality screening images of your colon.

Bowel prep pre-procedure is so essential because the residual fecal matter in the colon can either obscure existing polyps (resulting in a false negative) or may mimic a polyp that isn’t actually there (false positive). In the event that a suspicious lesion is identified on CT colonography imaging, you will be referred for follow-up with a traditional colonoscopy. This will allow for a tissue biopsy or removal of the lesion, which will be inspected under a microscope for cancerous cells. 

What to expect

Before the exam

Prior to the exam, your doctor may suggest that you only consume clear liquids within the 24 hours leading up to the exam. Additionally, a laxative is recommended for adequate bowel preparation leading up to your exam. As mentioned previously, any residual stool in the colon may either obscure existing polyps or mimic polyps that do not exist.

During the exam

A thin, flexible catheter will be inserted into the rectum, and air or carbon dioxide (CO2) is introduced. This will distend the bowel and make the contours of the colon more visible on imaging. This process may cause some cramping, which is typically mild and resolves soon after the exam.

When images are ready to be taken, you will be lying on your back on the CT scanner table. You will be asked to hold your breath for approximately 30 seconds in order to minimize motion that can distort the final image. You may also be asked to repeat the images while lying on your stomach, on your side, or both. The purpose of this is to shift any residual bowel contents into different positions (due to gravity). 

Conclusion

CT colonography is a valuable screening tool for colorectal cancer. With high sensitivity, convenience, and safety, CT colonography can help you take control of your health and detect colorectal cancer early.

Since it is a less invasive alternative to traditional colonoscopy, it can be useful for patients in need of early detection of cancerous and precancerous lesions. The sooner the abnormality is identified, the more quickly treatment can begin.

Radiology Associates utilizes the latest imaging technology, including state-of-the-art 3D CT scanners and specialized software, to capture detailed images of the colon and rectum. These images are then reviewed by our team of expert radiologists who are trained to identify any abnormalities or precancerous growths.

References

1. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21772

2. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

3. https://www.radiologyassociatesimaging.com/news-and-views/2021/11/30/new-guidance-for-colorectal-cancer-screening 

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945785/

   https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening 

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191267/

6. https://evidencemd.net/sites/default/files/Evaluating-Benefits-Harms-Colorectal-Cancer-Screening-Strategies.pdf

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493310/

8. https://www.whittington.nhs.uk/default.asp?c=42754

9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104149/

10. https://www.radiologyassociatesimaging.com/news-and-views/2022/3/17/why-everyone-should-get-screened-for-colon-cancer-at-45

11. https://www.uptodate.com/contents/screening-for-colorectal-cancer-beyond-the-basics#H4053849

What To Expect During MRI Screening for Prostate Cancer

BACKGROUND

According to the latest American Cancer Society statistics, about 1 in 8 men will be diagnosed with prostate cancer during their lifetime. Aside from skin cancer, prostate cancer is the most diagnosed cancer in men in the United States. It is more commonly detected in older men and non-Hispanic Black males, and a family history of this cancer can also heighten the likelihood of developing the condition. 

While the rate of prostate cancer cases may sound alarming, it is encouraging to know that newer technologies like Prostate MRI are dramatically improving the way we view and diagnose prostate cancer.

WHO SHOULD HAVE A PROSTATE MRI?

Prostate MRI has been shown to be very helpful in the management of patients with suspected or already diagnosed prostate cancer. The most common situations to obtain an MRI of your prostate include:

1. Screening for prostate cancer

2. Staging a known prostate cancer

3. Following prostate cancer in patients undergoing active surveillance

SCREENING FOR PROSTATE CANCER

Screening for prostate cancer is one of the most common reasons for your doctor to order a prostate MRI. If you have a blood test showing an elevated or changing PSA value, your doctor may choose to obtain a repeat blood test later or consider other options to evaluate for prostate cancer, such as a biopsy or MRI. 

You should keep in mind that an abnormal or elevated PSA value does not necessarily mean you have prostate cancer. Your PSA value can become elevated if you have a large prostate gland or if you have inflammation or an infection in the area. There is no specific PSA level below which prostate cancer can be entirely excluded. 

Several major published studies over the past several years (2,3) have demonstrated that using prostate MRI may prevent around 30% of unnecessary prostate biopsies. All while helping find more “clinically significant” prostate cancer and avoiding the detection of “clinically insignificant” cancer that may not affect the patient’s health.

STAGING A KNOWN PROSTATE CANCER

If you have undergone a biopsy that revealed prostate cancer, your doctor may choose to obtain MRI prior to treatments like radiation therapy or surgery to perform “staging.” This means using MRI to evaluate the size and location of the cancer before determining if it has spread outside of the prostate “capsule” or into any adjacent organs such as the seminal vesicles. 

This is important information that can affect what type of treatment is recommended, how to optimally remove or treat all the tumors, and how to determine your prognosis.

ACTIVE SURVEILLANCE

Active surveillance is sometimes referred to as the “watch and wait” treatment. This means your doctor thinks you have a “low-grade” cancer that may never need treatment or affect your health during your lifetime. 

After decades of medical evidence, it is now known that many prostate cancers do not harm an individual during their lifetime if left alone. However, determining which prostate cancers can be watched versus which ones should be promptly treated can be challenging. 

Prostate MRI plays a role in determining which cancers are more likely to need treatment. MRI is helpful to demonstrate whether the cancer may be a “higher-grade” or more aggressive than originally thought based on the initial biopsy. Also, we commonly perform annual follow-up MRI exams to see if the known cancer is changing in any concerning way that would prompt your doctors to initiate treatment.

WHAT TO EXPECT

Before the exam:

Prior to your appointment, you will need to answer some questions to confirm that MRI is safe for you and that you are directed to the best machine for your needs. It is important to let the scheduler know if you have any implanted medical devices or metallic foreign bodies so we can determine how best to perform your examination. 

Occasionally, we require an additional imaging exam or medical document review to make sure the MRI is safe for you. You will also be asked whether you have kidney disease since the examination is ideally performed utilizing intravenous contrast. The contrast is safe for almost everyone, but if you are on dialysis, we may perform the study without contrast.

During the exam:

The examination takes between 20 to 30 minutes to complete. You will be asked to change into a medical gown that is provided and will have a final screening process prior to entering the MRI room. 

It is very important that metal objects are left outside of the room unless approved, and that you answer the technologist’s questions accurately. During the examination, you will wear headphones to muffle any loud sounds from the MRI machine and will lie on your back while the technologist completes the test. Most patients find the MRI to be an easy, and sometimes relaxing, exam. 

In the past, some patients with claustrophobia were unable to complete the exam. However, our Open-Bore MRI machines have the largest opening available in the industry, making it an uncommon to rare situation that someone cannot perform the exam unless the condition is severe. If you are concerned about your comfort during the test, you should inform the scheduler when making the appointment and we will make sure to allow more time to assist you during the exam.

Why choose Radiology Associates Imaging Centers for your exam? 

Our state-of-the-art outpatient imaging centers have been performing Prostate MRI for over a decade. We complete thousands of these exams yearly, making us one of the highest-volume imaging centers in Florida. 

Additionally, we use the most advanced MRI technology and imaging techniques to perform the study so you can find comfort in knowing that you are always getting the best examination possible. 

The technical part of the MRI is only one aspect of obtaining a high-quality examination. Possibly the most important piece is the interpreting radiologist who is reviewing your images. At our centers, we use a select group of specially trained radiologists to interpret these exams to offer the best accuracy and consistency. Our radiologists are required to follow all the reporting guidelines set forth by the American College of Radiology, known as PI-RADS, which is the standard of care in prostate cancer imaging.

Written By Dr. John Gianini

References:

1.  American Cancer Society website: https://www.cancer.org/cancer/prostate-cancer.html (Last accessed 4/7/2023)

2. MRI-targeted or Standard Biopsy for Prostate-Cancer Diagnosis. New England Journal of Medicine 2018; 378: 1767-1777. 

3. Role of pre-biopsy multiparametric MRI in prostate cancer diagnosis: Evidence from the literature. Turk J Urology 2021 Feb; 47 (Supp 1): S65-S70.