Prostate Awareness 9: A Key Message For Men – Do An MRI First, Then A Biopsy

Today met up with Professor Mark Emberton and got some interesting news. The illness still diagnosed as being at Stage One, but other factors have emerged. These findings have highlighted the importance of men having an MRI before, rather than after, a biopsy.

There are different schools of thought regarding the best sequence when diagnosing the illness. Men who have a high PSA or other symptoms are normally asked to then have a biopsy. Depending on the results, they may then be referred for an MRI.

But there can be problems taking this route. The needles used in the biopsy can only reach certain parts of the prostate and may take random samples. This can produce a false result, because the needles may not reach cancerous areas, particularly those in the anterior.

If the biopsy shows a cancer, then the man is referred for an MRI. The MRI images can be hard to interpret, however, if the scarring and other side effects from the biopsy have not healed. My first MRI revealed the illness being at Stage One, but it was necessary to get more accurate images before going ahead with the HIFU.

The Second MRI

Had another MRI on August 22nd. This was a strangely relaxing experience for 45 minutes and was done with advanced technology at Nuada Medical. Here is an overview of the approach they use.

Arriving early at 7.30 am for the 7.45 appointment, I sat outside on the steps, writing in the sunshine till the door opened.


The staff gave me a couple of injections. One was a dye used to enhance the quality of the image. They gave me the choice of which radio station to listen to whilst in the scanner: Radio 4 or Music. Chose the cheery option.

Went into the scanner. This provided a great time to think, ponder on the important things in life and make plans for the next pieces of writing. The images were sent directly to LUA, plus I was given a copy of the disc.

The Results of the Second MRI

Met Mark on September 3. He went through the findings, which revealed that the illness is still at Stage One, but the make up of it has changed.

The original MRI highlighted certain parts of the prostate that showed a cancer. The second version shows that these parts could possibly have been left without treatment and we could have employed ‘watchful waiting’.

But the new images show that there is another section that will need treatment. This is in the part of the prostate that was difficult to examine in the original biopsy or see clearly in the subsequent MRI.

Mark says this is perfectly treatable. We will need to know more details, however, about that part of the prostate.

The process has provided some useful lessons. I had previously read that it is quite common for a biopsy that precedes an MRI to cause some difficulties with the imaging. This has proved to be so in my case.

A Change In Approach

More clinicians are now recommending starting with an MRI. Here, for example, is the view taken by the Birmingham Prostate Clinic.

At Birmingham Prostate Clinic, our practice is to carry out an MRI scan before a biopsy, in order to assess whether a biopsy is necessary.

What are the benefits of MRI before biopsy?

The MRI scan, combined with other assessments such as the PSA, PCA3 and trans-rectal ultrasound, may show a biopsy is not necessary. Thus as intervention which patients find uncomfortable and carries its own risks may be avoided.

A biopsy traumatises the prostate tissue, so an MRI undertaken soon after a biopsy can be unclear due to this tissue damage.

By undertaking the MRI before biopsy, your surgeon has the benefit of an independent view of your prostate cancer, reported by the consultant radiologist.

Enhanced MRI is particularly important for men who have anterior prostate cancer – this means the cancer has developed at the front of the prostate. The anterior is particularly difficult to accurately reach and assess via trans-rectal ultrasound, so there is a danger of anterior prostate cancers being missed. There are no difficulties in visualisation using MRI. A quarter of all prostate cancers develop in the anterior lobes.


Mark will now do a follow up targeted biopsy using a local anesthetic. We have set the date for doing that on September 14.

He has again underlined another message to men with prostate cancer at Stage One. Providing the illness is monitored properly, there is normally a lot of time to do research and make the right decisions. Onwards along the journey.

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