September is Prostate Cancer Awareness Month, an important time to educate about prostate health and prostate cancer.
Prostate imaging plays a key role in cancer detection. PSA (prostate specific antigen) blood test screening is currently recommended at ages 55-69 for men at an average risk of developing prostate cancer. PSA screening may start earlier for men with increased risk, including men with African ancestry, or a family history of prostate and certain other cancers. Your urologist or primary care physician can order the PSA.
An elevated PSA does not always mean that prostate cancer is present. PSA may be elevated for benign reasons, such as prostate infection, inflammation, or enlargement. Nevertheless, a significantly elevated or rising PSA level may warrant prostate imaging and/or biopsy.
MRI is the most sensitive imaging test to localize prostate cancer. Prostate MRI is generally a painless test that takes less than 30 minutes. Patients typically receive an intravenous injection of MRI contrast in their arm during the screening. These studies no longer require an internal probe placement, and patients can enter the MRI machine feet first to make the screening more comfortable. If abnormalities are found, a biopsy may be scheduled, using the MRI images to target findings for greatest accuracy.
Some patients undergo prostate biopsy for an elevated PSA, without prior imaging. For these patients, MRI may then be ordered for tumor staging purposes.
Additional reference: https://www.auanet.org/guidelines/prostate-cancer-early-detection-guideline
Cullen Ruff MD, FACR is a board-certified radiologist with Fairfax Radiology Centers; an associate professor at the University of Virginia School of Medicine, Fairfax, VA; and author of Looking Within: Understanding Ourselves through Human Imaging.