Magnetic resonance imaging is cutting back on the rate of false negatives and saving lives.
Magnetic resonance imaging is cutting back on the rate of false negatives and saving lives. By Patrick Flanagan
Tuesday, July 1, 2014
Photo by Robin May
Dr. Jeremy Laborde
Not only can a prostate biopsy create what most men consider an uncomfortable situation - there is nothing pleasant about having a thin needle inserted through the rectum, urethra or perineum to poke your prostate gland any number of times - but the tests oftentimes can result in a false negative. That means the patient has cancer; it's just undetected.
"The technique has been used for a long time," says Dr. Jeremy Laborde, a radiologist at Our Lady of Lourdes. "There are some problems with this technique. For one, you can't see the prostate cancer. It's a random sampling so you can have false negatives."
Between 10 and 25 percent of prostate biopsies come back with a false negative, says Laborde, which is one of the reasons prostate cancer continues to be a leading cause of death in men.
The outcome of the biopsy essentially depends on the location of the cancer.
"Whenever they place the needles in they can only go 17 millimeters deep, but if the cancer is further in, they're not going to sample it," explains Laborde. "You can get cancer anywhere in the gland, but for patients that have those cancers they're just out of luck. They'll go get screened, get a biopsy, and then they'll say they have no cancer, but their labs keep going up abnormally, and the patient gets anxious."
This creates an even bigger problem: late diagnosis, which gives the cancer time to spread and become more aggressive, where it begins to attack the lymph nodes, bones and other areas of the body, ultimately becoming untreatable.
This is where magnetic resonance imaging comes into play through a new technique developed over the last five to six years called multiparametric MRI, which allows specialized radiologists with the right equipment to create a visualization of the tumor physiology.
Laborde introduced the technique to Louisiana after undergoing intense training that included a fellowship at Northwestern University in Chicago.
He calls it "revolutionary," saying, "We're no longer just using MRI to look at anatomy."
"This is allowing prostate cancer to be managed similarly to breast cancer," explains Laborde. "We're starting to get in that direction where we can actually see the prostate cancer. Before, that wasn't possible."
For Lafayette attorney Shannon Hardy, Laborde's MRI technique proved a lifesaver.
The 48-year-old Hardy says after undergoing blood work in 2010, his results came back with elevated PSA levels, meaning he was at risk for prostate cancer. Yet a biopsy screening indicated no cancer.
Over the next few years, however, Hardy's PSA levels continued to rise, prompting a friend, Dr. Rodney Burns - Laborde's partner - to suggest an MRI.
"He told me about the benefits of MRI and how it helps with detection 100 percent," recalls Hardy. "I went in for the MRI, and it showed a growth on the anterior portion of my prostate - a difficult spot to get to with biopsy."
MRI Prostate Imaging is now offered at three hospitals in Louisiana, but Our Lady of Lourdes, says Laborde, was the first - which is why it has been attracting patients from Baton Rouge, New Orleans and other parts of the state. In fact, Lourdes officials say more than half of the program's business is coming from outside of the market.
The reason for the limited availability is largely a result of the cost associated with the MRI machine, which averages about $1.3 million.
"We started offering this in late 2011, and you need a cutting-edge computer to be able to do these techniques," says Laborde. "These machines are not widespread. Throughout the state, the average computer age is between eight and 10 years. It'll be a while before machines like this are common."