Instead of PSA test, should 45 year old & older men be offered a prostate focused MRI, to see if he needs a biopsy? (similar to colonoscopy)

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29 Replies

  • The PSA test is easy and cheep.An MRI after the biopsy to see if the cancer has spread makes more sense.

  • MRI only if the PSA test shows a red flag

  • My PSA test didn't show a red flag -- it was 2.7. The DRE showed a red flag.

  • The problem is the cost of the MRI. With inadequate (or no) insurance, the PSA test is a better alternative to skipping screening.

  • Mri only if PSA shows red flag or there are symptoms with a lower psa

  • PSA costs about $20

    MRI is minimally an order of magnitude more expensive

  • If it will give a more accurate view of what's going on, then yes. The problem with the PSA has nothing to do with the test. It has to do with unnecessary biopsies and eventual over treatment. Maybe the PSA could still be used, but the next step woudl be the MRI before biopsy.

  • Very palpable on my DRE test. When that dramatic, just go straight to biopsy. If DRE is OK, but PSA is high then do the MRI. Just my two cents.

  • I agree that an MRI is too expensive for routine testing. There are dozens of things we might be tested for every year for which an MRI might help, but do we want to spend many thousands of dollars in the absence of other indications? Also, MRI is pretty inconvenient for people and, I was told by an MRI technician, not always well tolerated. He told me that when they put some people in the tunnel for 20 to 30 minutes they get claustrophobic, panic, move, and/or demand to be pulled out.

    One day someone will invent a hand held scanner like the ones on Star Trek. Then we'll have an alternative.

  • You want a "healthy" 45 yr old to subject himself to an expensive, noisy test to see if he then NEEDS a biopsy? Seems redundant for what should be a low frequency occurrence of PCA at that age.

    the other answers are suggesting MRI AFTER PSA/DRE shows a problem, but before biopsy. Probably a better, more justified approach.

    What insurance company is going to pay for an MRI for that healthy 45 yr old?


  • Too expensive for one . Perhaps even a 45 year old with a familial paternal history would be better served by the algorithm of elevated PSA , abnormal DRE , biopsy , CT/bone scan then MRI as I was ??

  • A PSA can be sampled cost effectively by primary health care and if not elevated can readily discount fears. MRIs are too expensive and require a much higher level of participation by a wider range of health care professionals.

  • I say No only because of the way the question is posed. I do think that men should have an MRI before a biopsy is performed, but only if the PSA test suggests the possibility of PCa.

    MRI's are expensive and shouldn't be used as a screening tool, whereas the PSA test is cheap and simple and can be used for screening. However the MRI can be used to eliminate unneccesary invasive biopsies, with their associated risks. Ultimately though, the biopsy is the only way to be certain of a diagnosis.

  • psa is nice and easy...MRI FOR induces radiation which stimulates cancer growth

  • Biopsies cause holes in the prostate where blood and other fluids can leak out. One of those things could be PC cells. I had a perfectly normal shaped prostate at the time of my surgery. There was no PC in the seminal vesicles or the lymph nodes. A recent prostacint scan discovered a micro nodule of PC in my prostate bed. I have no metastesis any where in my body per CAT/MRI's and Bone scans. So the question is "how did the PC cells get into my prostate bed? I have been dealing with this disease for 17 years.

  • Biopsy's are invasive and uncomfortable and if you could tell from the MRI wheather one was necessary to determine conclusively, then yes. My PSA score was very low given how much cancer I had.

  • If the objective is to detect cancer if present, then the MRI is the most accurate test. But if the cost of the MRI on this scale (potentially every male over 45) is a showstopper, then we are left with what we have now. Cost of insurance will rise significantly.

  • It might be good.

  • I voted no because of the MRI cost and lack of availability in all areas of every state. An MRI is too costly for screening.

  • I feel an MRI would take the guess work out of the equation as to whether there is a tumor and how to treat it.

  • PSA testing is not always conclusive as my late husband was non secreting PSA and was diagnosed too late with aggressive advanced prostate cancer.

  • The problem with the MRi is expensive and no Insurance Company is going to pay for it unless they have real proof you may have cancer. I had two Biospys, I with 12 spec. and another with 18 spec. The doctor thought I might have cancer in one of the 18. Requested an MRi. Took two months before the ins. would approve it. They did it only after the doctor told them that I( at 75) had no other health problems. Most men at my age will never get an MRI with slow growth cancer. They will die from something else before the cancer kills them.

  • Start with the easy and cheap filter with the biggest holes, PSA & DRE. Once y'all have figured out which ball park you are playing in, then you can better choose which should be the next filter: repeat the PSA or go for the big bucks scans. I have never liked the idea of the 12 core biopsy, punching holes blindly that encourage the escape of cancer cells.

  • MRI may be contraindicated if staples are left in the abdomen or other metal like hip replacement. My staples had been in place for 18 years, so the MRI operator thought it would not be a problem. I was sore for a week afterwards and still don't feel normal after two months.

  • In November of 2010, I was diagnosed having prostate cancer via a DRE (digital rectal examination. My PSA at that time was 2.5. What had me going to urologist was because I had an issue called prostatitis. The result was a Gleason score of 8 later to be scored as a nine.

    In February 2013, I was diagnosed as having a PSA of 48 which subsequent bone scan showed extensive migration to the bones.

    I have has the following treatments:








    Taxotere with Neulasta

    I am no longer on any chemo. I am no longer taking treatments as their side effects are worse that whatever gain ai might receive from them.

  • Energy man should have a PSA test starting at 30 and desk with the results with competent people, In my opinion socialized medicine for the masses, is not very helpful for those with this terrible disease. I favored aggressive treatment 13 years ago when mets immediately took hold less than one year after primary treatment. At 70, I am alive because of testing and treatment. Besides, I do not want non Prostate Dancer specialists making decisions that affect me.

    Gourd Dancer

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