MRI is painless and noninvasive; it gives a three-dimensional scan of the body, producing images that are like slices of anatomy. It creates better pictures than CT scans (see below), but it’s expensive and time-consuming (an average scan lasts about 45 minutes). Also, being inside an MRI machine, according to one patient, is “like being a sardine in a can.” Some patients (5 percent or fewer) actually become claustrophobic while they lie in the machine’s tube-like embrace. To help prevent this, some hospitals play soothing music while patients are being imaged. (One bit of advice for men about to undergo an MRI scan: It really helps to relax, close your eyes and, if you can, try to go to sleep.)

Currently, MRI is not a first-line tool for staging prostate cancer. In one multi-center study, transabdominal MRI (an image taken through the abdomen) correcdy staged only 57 percent of men with localized prostate cancer and spotted only 60 percent of all malignant tumors. MRI tends to miss some prostate tumors and underestimate the size of others.

“In our experience,” concluded two University of California researchers, “MRI does not have high enough sensitivity or specificity for extracapsular extension, seminal vesicle invasion, or lymph node metastasis to be of use in staging clinically localized prostate cancer.”

However, in the future, a transrectal approach may—as in ultrasound— improve the picture. Recendy, a special coil, attached to a balloon and inserted in the rectum, has been developed that gives a more detailed picture of the prostate and its surroundings. Will this help doctors distinguish organ-confined from advanced disease (or, for that matter, from BPH)? This is uncertain; preliminary data suggest that this approach is only slightly better.

So, to sum up: At present, MRI doesn’t seem to be necessary in men who appear to have localized prostate cancer, based on the digital rectal exam, clinical stage and PSA.

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