written by Dr Thomas Dean MBBS (UNSW), FRCS (Edin) FRACS (Urol)
MRI (Magnetic Resonance Imaging) has been used in the investigation of prostate disease for many years, but was not widely accepted initially because of the time, discomfort, cost and poor results of the early techniques, which required the use of a very large probe inserted into the rectum. In recent years there has been renewed interest with the advent of what is called multi-parametric prostate MRI. This means that both anatomical and functional studies are performed, which has led to the study being very reliable at detecting high grade cancers with the added benefit that small insignificant cancers are not detected. This has the potential to be very beneficial, as there is now a major focus on avoiding treating prostate cancers that do not need to be treated and there is every reason to believe that MRI will facilitate this objective. Modern multi-parametric MRI techniques have been pioneered by units in the Netherlands and France and good data is available showing that it can, with a high degree of confidence, detect the aggressive cancers that need to be treated. The results from Europe have been replicated in Australia by Dr Les Thompson and others at the Wesley Hospital in Brisbane and it is my personal belief that this is the way of the future. One major hurdle is that there is no Medicare rebate for a prostate MRI study, which currently costs $500 to $1000 in a good unit. I predict that using MRI will be cost effective by avoiding unnecessary interventions, and will facilitate treatment decisions.
It is essential to be aware that prostate MRI has to be performed in a unit with the appropriate expertise both in performing the test and in interpreting the results. Currently this expertise is not widely available. We are fortunate at the Sydney Adventist Hospital that Dr David Smit is a specialist radiologist with specific expertise in prostate MRI. He has trained with Dr Jelle Barentsz in the Netherlands . He has visited Dr Phillipe Pouche in Lille, France for further training. Dr Barentsz and Dr Pouche are considered world leaders in prostate MRI.
Remember that prostate MRI performed without the necessary expertise may result in the need for a repeat study at further cost as well as a misleading result that may compromise your treatment.
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