MRI should be routine for all patients with localized prostate cancer? | Opinion: No

Vol. 42 (6): 1065-1068, November – December, 2016

doi: 10.1590/S1677-5538.IBJU.2016.06.04


DIFFERENCE OF OPINION

Joel B. Nelson 1

1 Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA


Keywords: Therapeutics: Neoplasms; Cryosurgery; Nephrectomy


One of the basic principles of medical care is that a diagnostic test should inform a clinical decision. If the test is uninformative, it is not useful; if no decision is to be made then a diagnostic test is not necessary. Indeed, performing a diagnostic test when it adds nothing to the decision-making process is not only a waste of healthcare resources, it is potentially harmful, leading to incorrect conclusions or more unnecessary testing. From this perspective, how could mp-MRI potentially inform the initial management of localized prostate cancer?

Men who are candidates for active surveillance based on low-risk prostate cancer (cT1c, PSA<10, Grade Group 1 (Gleason 3+3=6)) may be harboring a higher grade tumor that eluded the initial biopsy, particularly if it is anteriorly placed. mp-MRI has the promise of detecting this potentially more serious cancer and avoiding the risk of inappropriate observation.

Some have argued men with low-risk prostate cancer with a “normal” mp-MRI (PI-RADS 1) have very little risk of cancer progression. The promise of mp-MRI to provide a better risk assessment in men considering active surveillance is alluring.

 

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