Multiparametric magnetic resonance imaging (mpMRI) is a special type of scan that combines several different imaging techniques to create detailed pictures of your prostate. An mpMRI is about personalizing prostate cancer screening. It helps zero in on clinically significant tumors and gives more peace of mind when results are normal.
Hi Kristine. You make an excellent point. mpMRI in men with a hip replacement can be challenging because metal implants create susceptibility artifacts that distort the image and may obscure the prostate, particularly on diffusion-weighted imaging, which is key for PI-RADS scoring.
A single hip replacement is often easier to image than bilateral hip replacements, which can create overlapping artifacts that more directly obscure the prostate.
While 3T MRI is generally preferred for prostate imaging, 1.5T is often favored in men with metal implants because it produces fewer artifacts.
Newer MRI techniques and software can reduce distortion and improve image quality, allowing many centers to obtain adequate 1.5T scans without an endorectal coil. However, in some cases, imaging may still be suboptimal.
When an mpMRI is nondiagnostic or equivocal, clinical tools such as PSA density, and in some cases, biomarkers like the Prostate Health Index (PHI) can help guide decisions about whether a biopsy is needed.
Thank you for this thoughtful reply. Do you recommend a center of excellence that does the 1.5T scan? Not there yet but see it in the future and willing to travel. Local urologist not on board but I think it’s because we do not have a specialist trained to’ read thru’ the artifact. Would love to avoid trus. KW
So I'm speculating, but I'd surmise that most prostate cancer centers of excellence have very specific protocols and greater capabilities for managing this issue than most community-based health centers. I think your best bet is to search for a center of excellence in your area, then call to inquire about this capability. The key will be speaking to the right person:-))
Thank you. So many older gents have hip replacement. Our urologist is a hard ‘no’ on the 1.5T approach. I want to avoid trus bx. Surely AI has a workaround in this setting. Or a center that is doing the more limited scan could be recommended. Willing to travel! Thanks and best to you.
More on this test for those with hip replacement. I’ve heard there is new data on 1.5T.
Hi Kristine. You make an excellent point. mpMRI in men with a hip replacement can be challenging because metal implants create susceptibility artifacts that distort the image and may obscure the prostate, particularly on diffusion-weighted imaging, which is key for PI-RADS scoring.
A single hip replacement is often easier to image than bilateral hip replacements, which can create overlapping artifacts that more directly obscure the prostate.
While 3T MRI is generally preferred for prostate imaging, 1.5T is often favored in men with metal implants because it produces fewer artifacts.
Newer MRI techniques and software can reduce distortion and improve image quality, allowing many centers to obtain adequate 1.5T scans without an endorectal coil. However, in some cases, imaging may still be suboptimal.
When an mpMRI is nondiagnostic or equivocal, clinical tools such as PSA density, and in some cases, biomarkers like the Prostate Health Index (PHI) can help guide decisions about whether a biopsy is needed.
Thank you for this thoughtful reply. Do you recommend a center of excellence that does the 1.5T scan? Not there yet but see it in the future and willing to travel. Local urologist not on board but I think it’s because we do not have a specialist trained to’ read thru’ the artifact. Would love to avoid trus. KW
So I'm speculating, but I'd surmise that most prostate cancer centers of excellence have very specific protocols and greater capabilities for managing this issue than most community-based health centers. I think your best bet is to search for a center of excellence in your area, then call to inquire about this capability. The key will be speaking to the right person:-))
Best wishes to both of you, and I hope you all find the answer. https://www.cancer.gov/research/infrastructure/cancer-centers/find
Thank you. So many older gents have hip replacement. Our urologist is a hard ‘no’ on the 1.5T approach. I want to avoid trus bx. Surely AI has a workaround in this setting. Or a center that is doing the more limited scan could be recommended. Willing to travel! Thanks and best to you.
Thank you Dr. Holden for your insightful articles on prostrate cancer. Have you heard of the 4Kscore test? I have written about this test here:
https://ramkrishnan.substack.com/p/prostate-cancer-the-unwanted-family
Unfortunately, it is not available in all regions here in the US. It has a much higher specificity compared to PSA alone.
Hi Ram. Yes, I discuss it here https://open.substack.com/pub/keithrholdenmd/p/liquid-biomarkers-guide-smarter-prostate
Thank you, Dr. Holden, for your informative articles. This was quite interesting and informative. Much appreciated.
You're welcome.
You're very welcome.