Prostate MRI:what to expect

Your doctor may recommend a Prostate MRI to look closely at your prostate, especially if you have:

• A high or continuously rising PSA blood level.
• An abnormal digital rectal exam (DRE).
• A previous prostate biopsy that was negative, but your PSA levels remain high.
• A known diagnosis of prostate cancer, and the doctor needs to see exactly where it is or if it has spread outside the gland (staging).
• Active surveillance for slow-growing prostate cancer, using MRI to monitor for any changes over time.

A Prostate MRI helps doctors visualize:

• The different zones of the prostate gland, the seminal vesicles, and nearby lymph nodes.

It is particularly useful for identifying:

• Clinically significant prostate cancer (aggressive tumors that require treatment).
• Benign Prostatic Hyperplasia (BPH - a normal, non-cancerous enlarged prostate).
• Prostatitis (infection or inflammation of the prostate).

Yes. Because it is a "multiparametric" MRI, it involves several different types of imaging sequences combined. One of these sequences requires an injection of gadolinium contrast dye into an IV in your arm. Cancerous cells absorb and release this dye differently than healthy prostate tissue, making tumors much easier to spot.

When you read your Prostate MRI report, you will likely see a "PI-RADS" score. This is a standardized 1 to 5 scale radiologists use to rate how suspicious a spot looks.

• PI-RADS 1 & 2: Very low to low risk. Clinically significant cancer is highly unlikely.
• PI-RADS 3: Intermediate risk. It is unclear; significant cancer may or may not be present.
• PI-RADS 4 & 5: High to very high risk. Clinically significant cancer is likely present.

If you receive a score of 3, 4, or 5, your doctor will likely recommend a targeted biopsy to test the exact area highlighted on the MRI.

Yes, a clean lower bowel is important for a clear picture.

• You may be instructed to use a small enema at home a few hours before the scan to empty your rectum of stool and gas, as excess gas can cause image distortion (artifacts).
• You will likely be asked to empty your bladder right before the scan.
• Tell your doctor if you have any metallic implants, especially hip replacements, as these can affect the magnetic field and blur the images.

The scan is painless. You will lie flat on your back on a padded table that slides into the scanner. A specialized receiver pad (a surface coil) will be placed over your pelvic area.

You will hear loud knocking noises, and you will be provided with earplugs or headphones. It is vital to remain completely still, as the prostate is a small organ and any movement can blur the images.

The scan typically takes between 30 and 45 minutes.

After the scan, a specialized Radiologist will review the images and generate a report using a specific scoring system. Your urologist will discuss the results with you and determine the next steps.

• RadiologyInfo: MRI of the body
• ACR Manual on MR Safety
• FDA: MRI benefits and risks

A Prostate MRI is a safe, highly detailed scan that has revolutionized the diagnosis of prostate cancer. By accurately pinpointing suspicious areas and filtering out benign conditions, it helps patients and their doctors make highly informed, personalized decisions about whether a biopsy or treatment is necessary.