Right biopsy, right time

And although the work is in the early stages, the initiative's backers appear to believe MRI's usefulness will largely lie in a few areas: ensuring patients are only biopsied when needed, ending the practice of so-called "blind" biopsies, and increasing the confidence of urologists that "indolent" cancers are indeed indolent, and can thus be managed with a watch-and-wait approach.


"MR PI-RADS will be structured in a fashion similar to BI-RADS...and thus are expected to make as radical an impact on prostate cancer care diagnosis and treatment as BI-RADS have done for breast cancer care," AdMeTech's president Dr. Faina Shtern told DOTmed News by e-mail. "What it means in practical terms: We will be able identify lesions with 'low level of suspicion' so that instead of doing biopsy on almost every man with abnormal [prostate-specific antigens levels], we will be able to determine if biopsy is needed to begin with."

The MR PI-RADS backers believe all this could have cost savings. According to AdMeTech, almost 1 million men get unnecessary biopsies for prostate cancer every year, costing the health system nearly $2 billion. But MRI prostate scans, which at $700 to $1,000 cost half the amount of a typical biopsy, could ensure fewer men get the unnecessary procedures.

What's more, the biopsies that are done could be more accurate. Biopsies guided by MRI could help doctors target specific, suspicious lesions. Current biopsies, usually conducted with ultrasound, mean doctors are often flying "blind," the project's backers say.

"Since we can see the cancers not just outside of the prostate but inside the prostate, we can use MRI for things like guiding biopsies. So that instead of hopefully hitting the cancers, we'll direct the biopsy to the lesion that's most suspicious," Weinreb said. "There's really no other part of the body where you do random biopsies."

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