Are “manograms” a viable option in prostate cancer screening and risk assessment?


For several years, Dr. Jelle Barentz in the Netherlands has been a prominent advocate for the idea that we might be able to use imaging methodologies (prostate “manograms”, like breast mammograms for women) to screen for risk of prostate cancer — either along with or instead of PSA testing. This is a controversial idea for several reasons.

The basic premise has long been that early use of “manograms” could lower the necessity for prostate biopsies, thereby avoiding the risk for (and the cost of dealing with) the potential side effects and complications of all those biopsies each year and the fact that most men absolutely loathe having them done.

The most basic problem has always been the fact that the accuracy of currently available forms of imaging (up to and including 3 T multiparametric MRIs) have a well-documented potential to “miss” some clinically significant forms of prostate cancer while still identifying some clinically insignificant forms of prostate cancer. Then again … so do systematic TRUS-guided prostate biopsies!

The four other key problems include:

  • Access to high-quality MRI scanning, which varies from place to place and country to country
  • The considerable variation in the level of the skills of radiologists to read prostate MMRIs with high accuracy
  • The costs of widespread MRI scanning
  • The issue of minimizing the unnecessary use of gadolinium contrast agents currently required in the conduct of mpMRIs

We are not going to get into all of the details here about this issue. For those who are interested we recommend the following two recent articles on the Medscape web site:

Your sitemaster is of the opinion that, as the quality of imaging techniques continues to improve, and as the number of expert radiologists who can read those images with accuracy increases, and as social pressure increases (here in the USA) for lower healthcare costs, it is certainly possible that there will be increasing use of certain types of imaging (potentially including “fast” biparametric MRI scanning) in the identification of risk for and the early diagnosis of clinically significant prostate cancer. However, this is going to take time here in the US. The US healthcare system is not designed to encourage such a process. It is likely that such progress will occur sooner in place like Australia, Japan, and some EU countries, if for no other reason than the costs of MRIs are generally much lower there than they are in the US.

Equally, however, your sitemaster is dubious about whether we will ever reach the point at which “manograms” can ever be used efficiently and effectively to “screen” for risk of prostate cancer when used on their own. There is now considerable evidence to suggest that that is not even the case for “mammograms” as a method of screening for risk of breast cancer.

 

2 Responses

  1. Just to be clear, the data on mammography is debated because people are looking at the same data and coming to different conclusions, emphasizing some data and de-emphasizing other data.

    There is considerable evidence that annual screening with mammography lowers morbidity and mortality of breast cancer.

    With all due respect, it seems a prostate cancer information site should not be comparing the much debated and statistically complex controversy of mammographic screening for breast cancer with prostate cancer MRI screening.

  2. Dear Starr15:

    You are entirely entitled to your opinion. My point is only that both of these issues are highly controversial and for a very similar set of reasons. The biological developments of breast cancer and prostate cancer do, in fact, have a very great deal in common.

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