MRI scanning & prostate biopsy
Professor Declan Murphy is an international leader in all aspects of prostate cancer, including early detection. He has published many papers on this topic, and has particular expertise in the use of multiparametric MRI scanning and transperineal prostate biopsy to evaluate men suspected of having significant prostate cancer.
Multiparametric MRI Prostate
Declan has routinely used MRI scanning for all men suspected of having prostate cancer, and also those on active surveillance for low-risk prostate cancer for many years. He has published many papers on this topic which have helped advance the role of MRI in early detection of prostate cancer. His research into this topic have included studies correlating MRI and final pathology after surgery, machine learning and focal therapy, and the role of MRI and PSMA PET/CT in early detection of prostate cancer.
MRI now defines our approach
to early detection of prostate cancer
The evidence
The landmark trial which established the role of MRI prostate in early detection of prostate cancer is the PRECISION study. The results were first presented to the world at the EAU Meeting in Copenhagen in 2018 and simultaneously published in the New England Journal of Medicine. Declan Murphy presented the plenary discussion at the EAU following its presentation by Dr Veeru Kasi.
Our view
In a subsequent editorial in Nature Reviews Urology, Professor Murphy summarised the data from the PROMIS and PRECISION studies, and argued strongly for a paradigm shift to fully embrace the role of MRI as a triage tool for men with a clinical suspicion of prostate cancer.
Current paradigm
In his Nature Reviews Urology article, Declan presented this graphic to represent the new paradigm which positions MRI upfront as a key determinant of who should have a biopsy when there is a clinical suspicion of prostate cancer. If a prostate MRI is normal, many men can avoid a prostate biopsy.
Hear Declan’s views
Declan presented the plenary discussion at the EAU Annual Meeting in Copenhagen in 2018 when the PRECISION study was revealed.
Prostate Biopsy Technique
Transrectal vs Transperineal
Prostate biopsy may be performed in one of two ways. Traditionally, it is performed by passing the biopsy needle in and out through the rectum (transrectal prostate biopsy). It may also be performed by passing the biopsy needle through the skin between the rectum and the scrotum (transperineal prostate biopsy). Transrectal prostate biopsy is associated with significant risk of serious infection, and also with inaccurate results, and therefore there is increasing momentum towards the abandonment of transrectal prostate biopsy.
Exclusively Transperineal
Declan Murphy has been at the forefront of adoption of transperineal prostate biopsy worldwide and has exclusively performed prostate biopsy using the transperineal technique since 2007. Peter MacCallum Cancer Centre became the first (and only) Australian hospital to transition to perform all prostate biopsies using the transperineal approach under Declan’s leadership in 2010. Declan has published many papers and delivered many lectures on this topic around the world.
Undergoing a prostate biopsy
Transperineal prostate biopsy is performed under a short general anaesthetic as a day-case admission to the hospital. The procedure and typical after-effects are explained in detail by Professor Murphy during his consultation at the time of booking.
FAQs
Should all patients undergo an MRI scan prior to prostate biopsy?
Professor Murphy encourages all men to have an MRI scan if there is a suspicion of prostate cancer. For a significant proportion of men, a normal MRI may provide sufficient reassurance such that they may not require a prostate biopsy. For men with an abnormal MRI, the areas of abnormality can be targeted at the time of biopsy. Some men are not able to undergo an MRI scan eg if they have a pacemaker or cochlear implant, or if they suffer from severe claustrophobia. In such cases, a multivariable approach using other variables such as PSA levels, examination, family history and prediction tools are used to assess patients’ and advise on whether a biopsy should be considered.
My MRI scan is normal. Does this mean I don’t have prostate cancer?
The negative predictive value of MRI for out-ruling significant prostate cancer is very high at about 85-90% (according to a paper published by Professor Murphy and collaborators in 2020). This means that up to 10-15% of patients will have significant prostate cancer on a subsequent biopsy, although most of these cancers are very small and usually not very aggressive. Therefore a biopsy may still be recommended.
How much does an MRI prostate cost?
MRI prostate has a Medicare rebate when referred by a urologist and when certain criteria are satisfied. Australia has actually been one of the most progressive countries in the world in introducing a rebate in July 2018. This means that the vast majority of our new patients, and our patients on active surveillance, are eligible for a full rebate when referred for a prostate MRI scan.
Does it matter where I get my scan done?
Yes. Like many aspects of prostate cancer management, it does matter if you go to a centre of excellence. Our preference is to refer all patients for prostate MRI scan to our building partners at Bridge Road Imaging, who have two state-of-the-art 3T Siemens Skyra MRI scanners. There are no out-of-pocket costs for rebatable scans at Bridge Road Imaging. There are other centres across Victoria with high-volume experience in prostate MRI.
Does Professor Murphy perform transperineal or transrectal prostate biopsy?
Prof Murphy only performs transperineal prostate biopsy. This has been his practice since 2007.