Prostate cancer is one of the most common cancers, with more than 3,000,000 cases diagnosed each year. The diagnosis of prostate cancer can also be difficult, since it can be very slow-growing and have few if any symptoms until it is advanced. Some prostate cancers are considered clinically significant and require radiation or surgery. But many of them are not significant and only require careful monitoring on a regular basis. Much of the controversy around early detection of prostate cancer revolve around whether certain test results are leading to unnecessary overtreatment. A recent study demonstrates that imaging performs better than PSA test for prostate cancer detection.

Over the past five years, there has been ongoing controversy about utilizing a prostate-specific antigen (PSA) blood test to help in diagnosis. In years past, these were routinely done as part of screening for prostate cancer. But it was discovered that many such tests resulted in over-diagnosis of clinically insignificant cancers that, in turn, often resulted in prostatectomies or other aggressive treatment. 

A recent study done in England compared PSA testing with MRI screening or ultrasound in detecting clinically significant prostate cancer. The findings from the study were that MRI imaging detected significant cancers in about twice as many cases as did PSA testing. However, the use of ultrasonography did not substantially outperform PSA testing. 

With these preliminary findings, the report recommended that there should a developed protocol for when MRI is appropriate. A study member wrote “if MRI is to be developed for use as a screening tool, additional efforts will need to be directed toward standardizing the imaging procedures for more reproducible result.” 

One prospective hurdle clinicians (and anyone writing guidelines) may have to overcome in the future: MRIs cost significantly more than a PSA test, and insurers are not going to be thrilled at the prospect at this increase in cost for prostate cancer screening.