Imaging advocates say new reporting tools for MRI prostate scans could help make the modality more useful for men and possibly one day eliminate thousands of unnecessary prostate biopsies.

Currently, an international effort from radiologists is underway to standardize the reporting of MRI prostate scans in an effort to make the interpretation of scans more uniform. The results could make data-gathering for clinical studies easier and also ensure patients at last fully benefit from new MRI technologies that might transform the way prostate cancer cases are diagnosed, managed and biopsied, according to the initiative's backers.

"It's hard to get data across multiple institutions, hard to duplicate others' work," Dr. Jeffrey Weinreb, the American College of Radiology's representative in the initiative, told DOTmed News when we spoke about the current state of MRI prostate imaging. "It makes it difficult to use this clinically if everyone's using different reports and words."

The project, announced this week, is called Magnetic Resonance Prostate Imaging Reporting and Data System, or MR PI-RADS, and is modeled after a similar system that revolutionized breast imaging, the Breast Imaging Reporting and Data System, or BI-RADS, which began in the late 80s and standardized breast image reporting.

ACR said the new system, expected to be released next year, would be based on initial work done by one of its partners, the 22-year-old European Society of Urogenital Radiology. Also involved is AdMeTech Foundation, a Boston-based nonprofit that has run a campaign to promote imaging for prostate cancer, called "Where is our Manogram?"

Reporting for duty

The importance of developing standards is that MRI has advanced to the point where it can start to make a bigger difference in prostate patients' lives, the project's founders said.

Technological advances over the past few decades mean doctors now have a well-stocked arsenal with which to detect prostate cancer and possibly even gauge its aggressiveness, with techniques such as diffusion-weighted imaging, which checks cellular density (cancer's dense), in vivo MR spectroscopy, which can measure cell membrane turnover (cancer has lots of turnover), and dynamic contrast-enhanced scans, which give information on vascularity (cancer is very vascular).

"Keep in mind the prostate is about the size of a walnut, and we're trying to look for little tiny things in the prostate," Weinreb said about the technological challenges involved.

Right biopsy, right time

And although the work is in the early stages, the initiative's backers appear to believe MRI's usefulness will largely lie in a few areas: ensuring patients are only biopsied when needed, ending the practice of so-called "blind" biopsies, and increasing the confidence of urologists that "indolent" cancers are indeed indolent, and can thus be managed with a watch-and-wait approach.

"MR PI-RADS will be structured in a fashion similar to BI-RADS...and thus are expected to make as radical an impact on prostate cancer care diagnosis and treatment as BI-RADS have done for breast cancer care," AdMeTech's president Dr. Faina Shtern told DOTmed News by e-mail. "What it means in practical terms: We will be able identify lesions with 'low level of suspicion' so that instead of doing biopsy on almost every man with abnormal [prostate-specific antigens levels], we will be able to determine if biopsy is needed to begin with."

The MR PI-RADS backers believe all this could have cost savings. According to AdMeTech, almost 1 million men get unnecessary biopsies for prostate cancer every year, costing the health system nearly $2 billion. But MRI prostate scans, which at $700 to $1,000 cost half the amount of a typical biopsy, could ensure fewer men get the unnecessary procedures.

What's more, the biopsies that are done could be more accurate. Biopsies guided by MRI could help doctors target specific, suspicious lesions. Current biopsies, usually conducted with ultrasound, mean doctors are often flying "blind," the project's backers say.

"Since we can see the cancers not just outside of the prostate but inside the prostate, we can use MRI for things like guiding biopsies. So that instead of hopefully hitting the cancers, we'll direct the biopsy to the lesion that's most suspicious," Weinreb said. "There's really no other part of the body where you do random biopsies."