Staging Prostate Cancer - MRI, PIRADS, & PSMA | Are Biopsies Still Needed? | Mark Scholz, MD | PCRI

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Alex asks medical oncologist Mark Scholz, MD, about the latest imaging and other tests used in the diagnostic and staging process for men who have been recently diagnosed with prostate cancer or men who have had a high PSA, for example, and are investigating further to see if aggressive prostate cancer is present.

0:09 What is the role of 3-Tesla multiparametric MRI in staging prostate cancer?

0:46 What does PI-RADS mean?

3:08 Are both MRI and PSMA PET scan required for staging prostate cancer? In which order should they be done?

3:34 In which order should diagnostic and staging tests and imaging studies be used?

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The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.

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[sandrawesterlund]

I’m so happy for your channel. My husband has stage 4 prostate cancer. At end of year 6 . November starts 7th year. So much I could say but again I’m thankful for your channel.

[rjrkofchick]

Almost 2 years after my diagnosis I constantly turn to your channel for updates and to refresh my knowledge of prostate cancer trends and treatment information. You are an invaluable resource. I can’t thank you enough for being beside me in this journey.

[txervhd]

You Guys are Awesome! My PSA has been slowly going up (from 7.4 to 17.3 ) the past 8 years. Since my Dad died of prostate cancer in 1985 I have been watching my PSA like a hawk. Tested 4 times a year. Tried out many "diets" over the years and think the Mediterranean works best for me to keep progression slow. You just answered the most important questions for me about this subject. I had already committed to an MRI last week. Many Thanks for the confirmation.

[ralphkilling]

Alex & Dr Scholz u all are amazing

[dw]

Your channel is an authoritative and extremely useful source of information for which I am extremely grateful. Your videos also help guide me to other sources of information that when combined have greatly assisted me in making sound diagnostic choices and the interpretation of the results. One specific gap in my knowledge is in the management of ASAP. Would you be so kind as to address this pathology, follow on diagnostic tests and prognosis probabilities in an upcoming video. Thanks

[edyang]

Wonderful program，very educational， thank you all.

[chickengeorge]

In 2014 I was diagnosed with prostate cancer. Two biopsies both with Gleason 6 and Polaris screen put me in low risk category. I stopped all PSA tests and no follow up. Doctors wanted me to have radiation when PSA went up. I said no.

[TheProf]

Excellent series! My paternal great grandfather died from metastatic PCa to his liver (in 1918) - my paternal grandfather lived to the age of 94 with a slow growing PCa (listed as his cause of death) - my late father was diagnosed with Pca at the age of 67 and had radical surgery in 1992 (he passed in 2009 with "Metastatic Cancer to Liver and Brain"). Although my PSA is low (2.4 in July labs), it increased 0.50 ng/mL in 6 months. I also have some physical symptoms that my research indicates normally don't appear in early stage Pca, including elevated alkaline phosphatase level (lab lists it as 'High'). I also read in a number of journals, online, that statins and blood pressure medications, along with over the counter meds like Aleve, can cause a dramatic decrease in PSA scores. I have been on these medications for a few years now and my age is 67. I have also lost 12 pounds in the last 5 months. So I will see the urologist in 2 weeks ... a low PSA score does not necessarily mean that no PCa is present, from what I have read in a number of professional journals. Is this your opinion as well? Many thanks!

[John-hqem]

Whatever you do, don’t get the Urolift done for BPH, it prevents the use of MRIs for prostate cancer.

[mmazkoory]

Thanks for another very good informative information about prostate cancer .

[ДжонКазадор]

I just saw a video of a British Urologist who says that he diagnoses prostate cancer using the PSMA PET and no biopsy. He says if a man’s PSA is between 8-10 ng/mL and his PSMA PET indicates that there’s cancer in the prostate, then it’s 100% accurate and that he’s never had someone get a false positive so far.

[MrMediterrano]

Is there any other reason except costs, that after DRE, PSA-measurement, ultrasound and MRI, the next step should be a biopsy and not a PSMA PET/CT, eypecially if neither the ultrasound nor the MRI did not offer any clues as to why the PSA value is elevated?

[tomcat]

I was looking at one of your vlogs from about 4 months ago re PIRADS and determining treatment and Dr Scholz said that there was theoretical discussions that patients with PIRAD 5s might go on to have recurrence or progression. I'm a PIRAD 5 and Gleeson 3+3. I had an annual MRI scan and it showed no change in the tumour size. But now Im confused is PIRADS better than the Biopsy scoring? I've been on Active Surveillance for just over one year.

[johndemerse]

I am on AS Gleason 6, two lesions and on every MRI I have had (3), PIRAD 5 was the result. On every transperineal biopsy I have had (3) after the MRI, Gleason 6 is what has been found. Is PIRAD 5 sometimes not accurate or is the biopsy missing clinically significant prostate cancer?

[MrJdsenior]

My only question is where on the scale of a little cringe to hanging by your fingernails from the ceiling does the 'somewhat uncomfortable' of a prostate biopsy reside? Looking at the size of that needle, and thinking of getting twelve stabs from that puppy does not come across to me as any level of just uncomfortable. Going for MRI tomorrow, and hopefully that will rule out the stabbing. Also, I have a hard time buying that punching holes through cancerous lesions carries no additional risk of spreading those cells, just mechanically if nothing else. They used to grind uteruses into hamburger to remove them, but nobody I know of does that now, for exactly that reason.

[bill]

How do you know if your MRI is considered center of excellent?

[noviafuller]

My husband 54 year old, he just get diagnosed with prastate cancer he is 3+4 he is not sure if he should do the radiation are surgery what do recommend. I would approach your suggestion please.

[KDean]

BIOPSY IS BARBARIC.
ABSOLUTELY BARBARIC

[irfanghazanfar]

Please advise: I have enlarged Prostate 71cc volume diagnosed as BPH for almost 10 years, however this time PSA came up to be 4.56. along with UTI, Semen tests etc came normal am almost 59 . My Dr advised MRI and the MRI showed dwi/adc score 3 and PiRAD 4 .... but at the same time MRI couldn't determine cancer . Further every other organ shown to be completely normal in MRI with no evidence of Breach of Prostatic Capsule ... No bone damage etc, ,, meaning by that Everything is limited to Prostate .... MRI advise of Repeat PSA or Biopsy Urologist after taking all relevant test ruled out cancer and didnt go for Biopsy etc ....and put me on Antibiotics for UTI... and a repeat of PSA after completion of Antibiotics course I am still on AntiBio I would request for your opinion ...

[bjhelder]

Why can't we get PSMA instead of invasive biopsies as a standard - it is so much cheaper and easier.