"For three years Andrew Harder wondered if he had prostate cancer. In  he had routine blood work that revealed an elevated prostatespecific antigen PSA level. When PSA is above  nanograms per milliliter of blood it can be one of the first signs of a prostate tumor. Harders PSA was . By the time Harder saw a urologist it had skyrocketed to . His doctor recommended the traditional next step a transrectal ultrasound TRUS biopsy which involves taking random tissue samples from  cross sections of the prostate. Over the course of two years Harder  an MRI technologist would have three TRUS biopsies. They were all inconclusive. It is frustrating to have a bunch of biopsies with a rising PSA and no proof of cancer Harder said. After Harders third biopsy his urologist was ready to throw in the towel and thats when Harder was referred to Jinxing Yu M.D. at VCU Health. By then Harders PSA was around .  Yu is the director of oncologic and prostate imaging in the Department of Radiology http at VCU. Over the past five years he has developed diagnostic techniques using MRI technology to investigate difficult cases like Harders.  After one MRI Yu found Harders tumor. After that Yu performed a targeted biopsy guided by the MRI scanner allowing him to take tissue samples directly from the tumor. Harder finally had a diagnosis.  In  he started on a treatment plan hormone therapy for six months to shrink the tumor and prostate and then external beam radiation to finish the job. Today his PSA is normal. Other patients who continue to hit a brick wall with negative results from TRUS biopsies yet persistently high PSA levels may not be as fortunate.  A patient had  TRUS biopsies and his doctors still couldnt find a tumor Yu said. If you do not have this kind of advanced imaging sometimes a patient runs into a situation when a tumor cant be found and treated because its too late  it has already metastasized. He ends up diagnosed with cancer only after the tumor has spread to his bone or lymph nodes years later.  Precise imaging leads to detection Magnetic resonance imaging and targeted biopsy for the prostate have provided relief for patients like Harder who have not been able to get an accurate diagnosis. When caught early prostate cancer is highly treatable. Much like someone would have an MRI to investigate the cause of back pain the technology gives doctors eyes on what is happening in prostate tissue. VCU Medical Center is one of the major teaching hospitals in the country doing advanced multiparametric MRI which involves taking three different types of imaging sequences of the prostate.  Each of the sequences  T weighted imaging diffusionweighted imaging and dynamic contrast enhanced imaging  tells a story and together they can be used to make a diagnosis with more than  percent accuracy. Interpreting a prostate MRI to be able to correctly diagnose cancer is a skill that can take years to develop. Yu and his team look for certain patterns that are typical of cancer on each of the different sequences.  If we put those characteristic features together from each sequence then we can say with a high degree of confidence that this area is concerning for cancer and potentially target it for biopsy said Sarah Winks M.D. an attending physician in the Department of Radiology. An MRI can also help determine how aggressive a tumor is Yu said and indicates if the tumor extends outside of the prostate and involves other areas  all information that helps urologists and radiation oncologists determine the best course of treatment. Traditional meets emerging technology In addition to enhancing detection of prostate cancer magnetic resonance technology also enhances the biopsy process with a procedure called magnetic resonanceultrasound fusion biopsy. MRI scans are overlaid with realtime ultrasound images to guide the biopsy needle to the tumor. In  VCU Healths Department of Radiology supported by the Division of Urology in the Department of Surgery purchased ultrasoundMRI fusion biopsy equipment. Prior to this Yus team had performed targeted MRI biopsies with the patient being moved in and out of the MRI scanner as the needle was guided to the target area  a sort of stopmotion procedure that could take up to an hour. The new equipment has simplified and shortened the process to about  minutes.  A study published in  by the Center for Cancer Research found that fusion biopsy is  percent more accurate in diagnosing highrisk aggressive cancers than a TRUS biopsy. It is also much better at finding tumors in the anterior part of the prostate near where Harders tumor was located. Yu credits the technology and also having a dedicated team that can perform multiparametricMRI read the MRI scans and conduct biopsies with a very high success rate.  At most places there will be a radiologist reading the MR image and a clinician performing the biopsy. The person reading the image and person putting in the needle is different Yu said. Sometimes you dont get the same result. We do both. Thats one of our strengths. New path to diagnosis Yu has seen how MRI technology has changed prostate patients care. Five years ago  percent of patients with prostate cancer or a high PSA would never get any imaging Yu said. Right now I think probably  or  percent get imaging. Sometimes these are patients pushing their doctors for a referral as one of Yus patients did last year.  Last August Jim Grandon of Colville Washington discovered he had a PSA of .. It was elevated from the . measurement that he had registered for a few years. The rising PSA was cause for concern. Instead of going through with an immediate TRUS biopsy recommended by his urologist he decided to research next steps.  With just going in and doing a blind biopsy like most urologists will do you have anywhere from  to  percent success rate Grandon said. I found three or four places around the country with a biopsy success rate of over  percent. When I went back to my urologist he said Why spend money flying around the country when we can take care of you here I said Because  percent is better than  percent. VCU Medical Center was one of the places Grandon had researched to get his diagnostic testing done and a few phone calls later he was on a plane flying across the country to see Yu.  On his second day in Richmond Grandon had an MRI that showed a lesion. The next day Yu biopsied it. On the fourth day Grandon flew home and began researching treatment options. He opted for brachytherapy followed by external radiation at a clinic closer to home and recently completed his treatment.  A change in care  More and more physicians are hearing about and understanding the benefits of MRI technology for prostate care which has also been helpful in preventing overdiagnosis and overtreatment. According to the Center for Cancer Research study MRI targeted biopsies detect  percent fewer lowrisk tumors. These are tumors that would have never developed into a lifethreatening cancer but might lead a doctor and patient to treat it unnecessarily.  When Yu started prostate MRI screening in  his team performed about  scans per year. Now with the support of Massey Cancer Center Urology and Radiation Oncology they are doing about  multiparametricMRI and  imaging guided biopsies per year. He estimates the volume will continue to increase because VCU will attract patients not only from the Greater Richmond area but also patients such as Grandon from other parts of the country. Yu hopes the advanced technology means positive changes in the standard of care. He speculates that in the same way women have a baseline mammogram men would have a baseline prostate MRI and periodic magnetic resonance scans if warranted by bloodwork and family history."