Prostate-specific antigen (PSA) is a protein that is made by the prostate gland. The PSA blood test can measure these levels in a man’s blood. This test has been used over the last 30 years to detect prostate cancer at a very early stage, before it causes any symptoms.

However, the use of PSA has become controversial over the last 5-10 years. We now know that non-cancerous conditions are often the cause of elevated PSA. In the past, the standard of care was to perform a prostate biopsy, which is an invasive test, for men with an elevated PSA. Now, we at Washington University have been at the forefront of studying and developing better strategies to decide who does or does not need a prostate biopsy.

One of the technologies that has changed the field is prostate magnetic resonance imaging (MRI). Urologists have published a number of studies showing how prostate MRI can help determine your risk of actually harboring prostate cancer (i.e. if we should pursue biopsy). In one study, we found that a “positive” (or abnormal) MRI drastically changed a man’s risk profile compared to a “negative” (or normal) MRI.

Washington University also uses an  ExactVu micro-ultrasound system, an advanced prostate testing and biopsy tool. Using extremely high frequencies, the technology takes highly detailed pictures to find the precise location of the prostate cancer. Jerry Andriole, MD, explains the importance of this medical device and how it can help men with elevated PSA levels below.

We know that experience of the center performing the prostate MRI and the experience of the radiologist interpreting the MRI is critical to a useful result. We have performed over 1000 prostate MRIs in the past 4 years at Washington University. With a quality MRI, we are able to use new technology to perform a software-guided prostate biopsy in the operating room (with the patient under sedation). MRI performed outside of Washington University may not be adequate for software targeting.

Currently, we have a number of clinical trials open where we are using both blood and urine biomarkers in combination with prostate MRI to further improve the risk prediction prior to biopsy. Our eventual goal will be to deliver the best care to patients with an elevated PSA, by eliminating all unnecessary biopsies.

Washington University urologists are experts in interpreting the results of PSA tests and using the newest technology, such as prostate MRI, to correctly decide when a biopsy is needed and when it is not. We use the newest technology to perform software-guided MRI targeted biopsies, which is available at leading academic medical centers.

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