Learning About Prostate MRI for High Prostate-Specific Antigen (PSA) Levels

Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. When you have a prostate MRI, images are taken of the prostate gland.

The prostate gland is part of the male reproductive system. It’s a small organ that lies just below the bladder and in front of the rectum. It wraps around the urethra. This is the tube that carries urine and semen out of the penis. The prostate makes some of the fluid in semen.

Prostate-specific antigen (PSA) is a protein made by cells in the prostate gland. The prostate releases PSA into the blood. A high PSA level in your blood may mean that you have an enlargement, infection, or cancer of the prostate. Prostate cancer is the abnormal growth of cells in the prostate gland.

When you have a high PSA level, an MRI may be done to look inside the prostate for cell changes that might be cancer. Your doctor can use the results of an MRI to decide on further tests, such as a biopsy.

Before the MRI test, you may be asked to use an enema to help clean out the rectum. You may have contrast materials (dye) put into your arm through an intravenous (I.V.) line. You will feel a warm flush go through your body after the dye is injected.

During the test, you will lie on a table that is part of the MRI scanner. A small, thin device may be inserted into the rectum to get more detailed images of the prostate. This device is called an endorectal coil.

The table will slide into the part of the machine where the images are taken. Inside the scanner you’ll hear a fan and feel air moving. You may hear some loud noises, like tapping or thumping. You may be given earplugs or headphones to reduce the noise.

The technologist will ask you to hold still while images are taken. They may ask you to hold your breath for a short period. You may be alone in the MRI scanner room. But the technologist will watch you through a window and talk to you during the test.

If you get nervous in tight spaces, tell your doctor. You may get a medicine to help you relax during the MRI test.

A radiologist looks at the MRI images for abnormal cell growth that may be prostate cancer. The results are usually ready for your doctor in 1 or 2 days.

The results may include a PI-RADS score. PI-RADS stands for “prostate imaging reporting and data system.” This score reports the likelihood of prostate cancer that is clinically significant. Cancer that is clinically significant is more likely to cause symptoms or spread to other parts of the body.

If the score is:

• PI-RADS 1, the likelihood is very low.
• PI-RADS 2, the likelihood is low.
• PI-RADS 3, the likelihood is intermediate.
• PI-RADS 4, the likelihood is high.
• PI-RADS 5, the likelihood is very high.

If your MRI results show an intermediate, high, or very high likelihood of clinically significant prostate cancer, your doctor may do a biopsy. Small tissue samples will be taken from your prostate. This may be done with another MRI. The samples are looked at under a microscope to see if there are cancer cells.

If you have a low likelihood of cancer, a biopsy may still be done. It depends on your other risk factors for prostate cancer. These include age, ancestry, family history of breast or prostate cancer, and your other test results.

If a biopsy finds prostate cancer, you and your doctor will go over your treatment choices. One option is active surveillance. With this option, you will have regular checkups and tests. But you don't need other treatments, like surgery or radiation, unless the cancer gets worse. This may be an option if you have low-risk cancer that has not spread outside the prostate.