What are the advantages and disadvantages of having an MRI scan before a biopsy?

Advantages

• It can give your doctor information about whether there is cancer inside your prostate, and how quickly any cancer is likely to grow.
• It’s less likely than a biopsy to pick up a slow-growing cancer that probably wouldn’t cause any problems in your lifetime.
• It can help your doctor decide if you need a biopsy – if there’s nothing unusual on the scans, this means you’re unlikely to have prostate cancer that needs to be treated. You may be able to avoid having a biopsy, and its possible side effects.
• If you do need a biopsy, your doctor can use the scan images to decide which parts of the prostate to take samples from.
• If your biopsy finds cancer, you probably won’t need another scan to check if it has spread, as the doctor can get this information from your first MRI scan. This means you can start talking about suitable treatments as soon as you get your biopsy results.

Disadvantages

• Being in the MRI machine can be unpleasant if you don’t like closed or small spaces.
• Some men are given an injection of dye during the scan – this can sometimes cause mild side effects.

What does an MRI scan involve?

Before the scan the doctor or nurse will ask questions about your health. As the scan uses magnets, they will ask whether you have any implants that could be attracted to the magnet. For example, if you have a pacemaker for your heart you may not be able to have an MRI scan. You’ll also need to take off any jewellery or metal items.

You will lie very still on a table, which will move slowly into the scanner. MRI scanners are shaped like a doughnut or a long tunnel. If you don’t like closed or small spaces (claustrophobia), tell your radiographer (the person who takes the images).

The radiographer might give you an injection of a dye during the scan. The dye helps them see the prostate and other organs more clearly on the scan. It is usually safe, but can sometimes cause problems if you have kidney problems or asthma. So let the radiographer know if you have either of these, or if you know you’re allergic to the dye or have any other allergies.

The scan takes 30 to 40 minutes. The machine won’t touch you but it is very noisy and you might feel warm. The radiographer will leave the room but you’ll be able to speak to them through an intercom, and you might be able to listen to music through headphones.

Getting the results

Your MRI scan images will be looked at by a specialist called a radiologist, who specialises in diagnosing health problems using
X-rays and scans. The radiologist will give the images of your prostate a score from 1 to 5. You may hear this called your
PI-RADS (Prostate Imaging – Reporting and Data System) score or your Likert score. It tells your doctor how likely it is that you have cancer inside your prostate.

PI-RADS and Likert scores have the same values, and your score will be between 1 and 5.

• PIRADS or Likert score 1 It’s very unlikely that you have prostate cancer that needs to be treated.
• PIRADS or Likert score 2 It’s unlikely that you have prostate cancer that needs to be treated.
• PIRADS or Likert score 3 It isn’t possible to tell from the scan whether you have prostate cancer that needs to be treated – you may hear this called a borderline result.
• PIRADS or Likert score 4 It’s likely that you have prostate cancer that needs to be treated.
• PIRADS or Likert score 5 It’s very likely that you have prostate cancer that needs to be treated.

If your PI-RADS or Likert score is 1 or 2, this means you’re unlikely to have prostate cancer that needs to be treated. Your doctor may decide that you don’t need to have a biopsy.

They may suggest you have regular PSA tests so that any changes in your PSA level are picked up early. You’ll also be offered treatment for any urinary symptoms.

If your PI-RADS or Likert score is 3, your doctor will look at your other test results to help decide whether you should have a prostate biopsy to check for cancer. If they don’t think you need a biopsy, you’ll be offered regular PSA tests to check for any changes in your PSA level.

If your PI-RADS or Likert score is 4 or 5, you’ll usually be offered a prostate biopsy to find out whether you have cancer.

References

Updated January 2019 | To be reviewed January 2021