How MRI is Used in Prostate Cancer

Magnetic Resonance Imaging (MRI) may be used in two main ways when a patient is found to have an elevated PSA. First, MRI can highlight suspicious areas, indicating the potential presence of cancerous lesions and helping to determine whether a biopsy is needed.

PI-RADS (Prostate Imaging Reporting and Data System) is a structured reporting system to evaluate for the likelihood of prostate cancer based on an MRI scan. The scores range from 1 (very low/clinically significant cancer is highly unlikely to be present) to 5 (very high/clinically significant cancer is highly likely to be present). PI-RADS 4 or 5 lesions have a high probability of being clinically significant disease and typically warrant targeted biopsy for confirmation.

If it is determined that a biopsy is needed, MRI-“targeted” or “fusion” biopsies are increasingly being offered at select centers that use MRI, in addition to the ultrasound, to better visualize tumors within the prostate and help guide biopsy needles to the areas that appear to be most suspicious.

When choosing a location for your MRI, here’s why it matters: MRI technology is like fine photography. Just as excellent photographers will put the subject in focus and the background out of focus, this should happen with an MRI as well. There is variation in the quality of an MRI; if possible, MRI and fusion biopsy should be performed and interpreted at a high-volume center with particular expertise in prostate MRI. Research for the improvement of this technology continues.

Last Reviewed: 12/2023