Prostate biopsy using nuclear magnetic resonance

It is the most accurate test for the diagnosis of prostate cancer, which affects millions of men worldwide. According to official data, in 2022, 3,820 new cases were diagnosed in the Dominican Republic. However, most of these are detected at an early stage and pose low risk, posing little or no threat to the patient from their early stage diagnosis.

From what age and how regularly should men go to the urologist?

Prostate cancer is the most common cancer in men and is the second leading cause of death from cancer. As a general rule, from the age of 45 an annual urological check-up would be recommended to the general population, even without urological symptoms. If the patient presents urological symptoms, the evaluation is independent of age, and the influence of family history is very important. If these are present, it is recommended from the age of 40 or even earlier.

What influence does family history have and what risk factors influence it?

Family history is very determining, in case of previous involvement of a first-degree relative (father or brother), the risk of suffering from prostate cancer is double, and if there are two, the risk is multiplied by 10 times. In some varieties it is also associated with a history of breast and ovarian cancer in the mother or sisters (due to prior hormonal and genetic alteration). Regarding dietary factors, animal fats, arterial hypertension, obesity, excessive alcohol intake and excessive intake of whole cow’s milk (due to associated fats) have an influence. As preventive factors are foods rich in vitamin E and D, selenium, zinc, isoflavones, carotenes, and lycopenes (fruits, vegetables and cereals), especially natural tomatoes and carrots, nuts, among others.

What characteristic symptoms do patients present?

On many occasions the diagnosis is made in a routine consultation without presenting any symptoms when the disease is located inside the prostate (hence the importance of early diagnosis). If the disease begins to leave the prostate and spreads to other organs, you may present with pain when urinating and a decrease in the urinary caliber (dysuria), blood in your urination (hematuria), frequent and urgent desire to go to the bathroom (urge urination ), blood in the ejaculate (haemospermia), bone pain and general fatigue, erectile dysfunction, pain in the perineal area when sitting, driving or riding a bicycle or motor.

What are the main advances that have occurred in diagnosis?

For decades, the tumor marker in blood called PSA (prostate specific antigen) marked a before and after in the suspected diagnosis of this disease. On the other hand, imaging tests are also essential for the diagnosis of prostate cancer, but the greatest advance in recent years has been the innovation of the technique: resonance-guided prostate biopsy. The most accurate radiological test today is high-resolution magnetic resonance imaging, which makes it possible to differentiate and identify suspicious areas of prostate growth with great precision through a simple classification called PI-RADS, whose score ranges from 1 to 5, being grade 5 lesions very highly suspicious for malignancy.