Current diagnostics for raised PSA
Posted , 9 users are following.
12 months ago PSA raised from 2.5 to 6.4. Had the MRI 3T and biopsy and given the all clear. Just put it down to worsening BPH.
Now my PSA has risen from 4.4 to 8.6 so the consultant goes down the usual route of recommending another MRI and possible biopsy. So frustrating that in 2017 we still don't have good pain free diagnostic testing for prostate cancer. I don't think i have too much choice but to go down the same route again because you always have in the back of your mind prostate cancer. Although, I was reading Dr Scurr's page in the UK Daily Mail today and he was quoting for every 1000 men that have gone down this route just one has had prostate cancer. Anybody on here had similar experiences and decided not to go down the MRI route and biopsy?
ps - is it the scan only that uses the MRI 3T and they then use this to target suspect areas when taking biopsies or is there an option out there to have an MRI biopsy for greater accuracy, like FLA.
0 likes, 28 replies
paul44935 andyr0
Posted
For what it's worth: My PSA is 12+, had an MRI and then a biopsy, benign result. So many reports say that PSA is not a reliable indicator. My Canadian urologist suggested when asked that American doctors in his opinion are overly aggressive. I don't plan another biopsy without really compelling reason.
kenneth1955 andyr0
Posted
andyr0 kenneth1955
Posted
Wow there is a whole load of information for me there. I am from the UK and I think us prostate guys are less well informed than you guys in the States. Most of us also use the public health care scheme - the NHS. I think your posts reveal the gap between private and public funding.
I had my last biopsy 2 years ago, TRUS 12 core all clear. The MRI I had done before the biopsy showed some suspicious areas.(We don't have 3T MRI , just 1.5T in the NHS.) I think the score was 3. I didn't know you could have a MRI guided biopsy but won't be available on the NHS.
I don't know what my prostate volume is, nor %free PSA, density or volume. Rest assured I will be asking to see my MRI results and asking for this additional information. I will be having the MRI in 2 to 3 weeks time so will post again. I will be discussing many of the issues you raise with my consultant and may consider going private for the diagnostics. Thanks so much for all of your information and knowledge sharing and come on you Brits let's hear from you as well.
JerseyUrology andyr0
Posted
Unfortunately, according to my radiology friends (who may be a bit biased, as they participate in clinical trials for prostate cancer diagnosis using a 3T MRI machine), a 1.5T MRI just doesn't given enough resolution to be worthwhile in the diagnosis of prostate cancer.
andyr0 JerseyUrology
Posted
Just read this whilst i was researching the 1.5T versus 3T so maybe not as bad as it seems. I know I was in the MRI for at least half an hour to 40 minutes last time.
'You can still get beautiful images with a 1.5T system using multi-channel phased array coils, but scan times are longer than a 3T'
MichaelVM7 andyr0
Posted
Diffusion weighted, multi-parametric 3T imaging is the present gold standard for non-invasive diagnostics.
TRUS biopsy is guided by ultrasound.
MRI fusion Bx overlays the MRI image and the Urologist uses that higher resolution image to guide the placement of the needles. It allows for targeting of areas of suspicion seen from the MRI.
A PIRADS score of 3 is considered indeterminate for the presence of clinically significant cancer. Basically, the imaging is unsure. PIRADS of 1 means almost certainly no cancer present whereas PIRADS of 5 means highly likely a significant cancer (Gleason score 6 or higher) exists.
The U.S. arguably has the best medical care in the world. Of course President Obama sought to derail that seven years ago via the Affordable Care Act. America does not need nor want socialized, government controlled medicine.
I hope you get your answers Andy.
God bless and keep you.
Michael
zdzislaw MichaelVM7
Posted
kenneth1955 andyr0
Posted
Andy. Good luck to you but don't let them rush you into any surgery.I had a 13 core biopsy when I was 47. the doctor sent me to the urologist she told me I had cancer my PSA was 426. Get all the information you can Talk later my friend KEN
MichaelVM7 zdzislaw
Posted
That may well be.
However, US hospitals and US medical schools dominate the world rankings and have for years.
People from the world over come to Johns Hopkins, Mayo Clinic, Cleveland Clinic, UCLA, UCSF, Univ of Michigan, Baylor Medical, Sloan Kettering, Mass General, MD Anderson, Northwestern Memorial, and many more for truly world-class, cutting edge healthcare. And the best students the world over come to US medical schools, of which essentially only Cambridge and Oxford compare.
But I have no reason to question France's health care.
Thanks,
Michael
craig84609 andyr0
Posted
If you have a 3T MRI and it is clear what is the point of a biopsy. If my doctor told me that I needed a biopsy after a clear MRI I would tell him or her to go pound sand. The 3T MRI should tell them if a biopsy is needed. If something suspicious shows up then a biopsy of that area is warranted, but to do a biopsy after a clear MRI just doesn't make sense to me. That is one reason why I didn't want a PSA test done, I figured I would embark on a journey of repeat testing for several years and biopsies are harmful to the body. Not something I take lightly. Lukily my PSA is .24, but that shows you how unacurate the PSA test can be, as I have an enlarged prostate, but low PSA. I was told that I have BPH. So, high or low it doesn't always mean you are clear or have cancer. I think the best possible test is the 3T MRI, I would trust it for myself. However, I am not a doctor and what I feel is right for me isn't going to be right for you, you have to decide what you would like to have done. Take care.