MRI scan

Introduction

An MRI (magnetic resonance imaging) scan uses magnets to create a detailed picture of your prostate and the surrounding tissues.

In many hospitals you may have a special type of MRI scan, called a multi-parametric MRI (mpMRI) scan, before having a biopsy. This can help your doctor see if there is any cancer inside your prostate, and how quickly any cancer is likely to grow.

In other hospitals, you may have a biopsy first, followed by an MRI scan to see if any cancer found inside the prostate has spread.

Not all hospitals are able to do mpMRI scans before biopsy, but your doctor may be able to refer you to one that does.

An MRI scan may not be possible if you have a pacemaker or other metal inside your body.

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

List of references
- Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. The Lancet. 2017 Jan;
- Fakhran S, Alhilali L, Kale H, Kanal E. Assessment of Rates of Acute Adverse Reactions to Gadobenate Dimeglumine: Review of More Than 130,000 Administrations in 7.5 Years. American Journal of Roentgenology. 2015 Mar 20;204(4):703–6.
- Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. New England Journal of Medicine [Internet]. 2018 Mar 18 [cited 2018 May 4]; Available from: http://www.nejm.org/doi/10.1056/NEJMoa1801993
- MRI scan - Who can have one? - NHS Choices [Internet]. [cited 2015 Dec 3]. Available from: http://www.nhs.uk/Conditions/MRI-scan/Pages/Who-can-use-it.aspx
- National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
- Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, et al. Gadolinium-Based Contrast Agents in Kidney Disease: Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Canadian Association of Radiologists Journal. 2018 May;69(2):136–50.
- Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. European Urology. 2016 Jan;69(1):16–40.

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