Looking Good: Prostate Cancer’s Sharper Image

Prostate cancer continues to be a scourge on the Canadian health landscape as the most commonly diagnosed and third leading cause of cancer-related death among men (1). It currently accounts for about 20% of all new cancers in men and approximately 4,500 deaths annually (2).

But the landscape also points to a good news horizon. Thanks to improved screening and treatment, prostate cancer mortality continues to fall, dropping from its’ high of 45.1 deaths per 100,000 men in 1995 to 22.7 per 100,000 in 2021 (1). One of the more remarkable advances in the screening and diagnosis of this malignancy is the use of imaging studies, such as the prostate MRI. From the earliest images 40 years ago using magnetic resonance imaging technology, the current prostate MRI uses state-of-the-art image modalities such as dynamic contrast-enhanced (DCE) and spectroscopic views to get a better look in order to detect clinically significant prostate cancer (3). The impact on detection, accuracy and diagnosis is a major contributor to improved prostate cancer mortality. Prostate MRIs are also increasingly utilized to monitor for prostate cancer recurrence after treatment, no doubt also contributing to improved mortality.

One particular area of interest is how MRIs are also transforming the collection of prostate tissue necessary to confirm whether a prostate lesion is cancerous or benign. For decades, the traditional method has been to use an ultrasound-guided biopsy needle to obtain the desired tissue samples. MRI-directed biopsies are starting to be recognized as a potentially more sensitive method of detecting clinically significant tumors. At the same time, this could reduce the number of overall and often unnecessary prostate biopsies, an intrusive and often painful procedure.

Along with awareness, physical exams, prostate-specific antigen (PSA) blood testing and the tremendous advances in treatment, MRI-guided prostate imaging promises to keep more prostate cancer cases looking better and better.

References

1)    Woo, Andrea. Breakthroughs in Cancer Treatments, Medical Imaging Have Slashed Prostate Cancer Death Rate. Globe and Mail. November 3, 2021.

2)    Canadian Cancer Society. Cancer Statistics at a Glance. Canadian Cancer Society. November 2021.

3)    American Journal of Roentgenology. The Evolution of MRI of the Prostate: The Past, The Present and the Future. Genitourinary Imaging Review. August 2019 (Volume 213, Number 2).