How Accurate is 3T MRI

Hi aksns, I was hoping that because my numbers had dropped from 7.5 to 4.3 within 2 weeks (different lab granted but 3.2 ng !!) I was hoping I had an infection of the prostate.....what amazes me is that no one has said to me "Hang on here, lets cool it and redo the PSA"....I still dont know now what my current PSA is...has it dropped? stabilised? risen?  The National Health Service are throwing procedures at me like a drunken sailor on shore leave. I suppose I should be grateful.....Just want to hope that the "something" that they can see on the images isn't something "nasty".....Maybe it was the radiologists first day 

My doc (regular GP) told me that PSA tests sequence should be OVER a month apart to be reliable. Here in the US, its a standard 3 months, because many many external influences throw off the results, including having any health condition where your taking an antibiotic or recent vaccination. I had 2 types of PSA tests, including the PSA free test which gives more information than the the everyday variety. I am surprised that none of your docs suggested a longer period of time in-between tests. Our insurance limits the number of tests, unless there is a compelling . reason. Once they said- hang on, they should have waited at least 4 weeks. PSA is only a indicator, nothing more. Getting repeated tests in a short time period isn't recommended here in the US. Please look at PSA testing guidelines published by Natl Inst of Health, Johns Hopkins and Mayo Clinic, available online.

Hi, I only had the second test done (paid privately) because the NHS in the UK don't fund Free PSA tests (fair enough)....Went to a private clinic and had the lab test done (new reading 4.3 free PSA 23%) part of the deal was a consultation with a urologist at the clinic....Got the top dog there...Here in the UK he's very well known, always in the papers on TV talking about mens health etc. Written around 40 books on the subject. It was him that said I didn't have cancer.....(after a 40 minute consultation and a DRE).....maybe he got a bit carried away....Like a typical man I wanted to believe him...I was all for forgetting the NHS tests and walking away.....My wife had other plans.....Hell! he may even be proved right (I hope)...I appreciate that you shoiuldn't have tests too close together because of natural fluctuations in PSA but I don't think 3.2ng in 2 weeks could be called a natural fluctuation....assuming someone at either lab didn't make a boo boo something has caused that hike and subsequent drop

  Thank you for your input

    regards   Tony

I've deleted the post with the link so users can use the Private Message service to ask for it if required. However, I have noted the site as I will be adding pinned discussions to the 2 prostate groups when I get time with links to useful resources. I'll include the links from aksns61 if suitable. For an example of what I mean see link below from another group in the forums.

https://patient.info/forums/discuss/thr-useful-resources-487147

Regards,

Alan

Hi Barney, thanks for your reply, I'm fairly new to this merry go round of madness but thanks to people who "have been there" I'm slowly getting a grip on it. I live in the UK and because of that I am having all these tests via the National Health Service....Back home in the UK they get a bit of a bad press sometimes, but it's a vast organisation so of course bad stuff happens sometimes....Thus far I have very good service, apart from a couple of "grumpy" docs....I've had expensive medical procedures thrown at me, whether I wanted them or not....I've had a cystoscopy (all good), a CT Urogram, a 3T MRI and am due a biopsy in 2 weeks (because of the "something small" on the image)....Being a guy I would have happily gone without the MRI and the biopsy and put my fingers in my ears and sang "La La La" at the top of my voice....It's my wife that had other ideas....because I'm under the NHS I don't really get a lot of choice as to the procedures involved, I get what I'm given.

  When my PSA came back at 7.5 I freaked a bit and while waiting for the hospital to get in touch I went to a private clinic in London and paid to get my free PSA checked (the NHS don't do the free PSA test)....That is when my PSA came back at 4.3 and the free PSA was .98 or 23% of the total.....That reassured me for a while.....Plus part of the deal of having the test was, I had to have a consultation with a consultant at this clinic.....(They specialise in Prostate problems and mens health)....I was lucky enough to get their director who is a very well known figure in the field of urology....He's the "go to guy" in the UK if the media ever want a story or quote regarding prostate health/cancer whatever....He's very well respected internationally and has written around 40 books and scientific papers on the subject.....This is the guy who gave me the DRE and said unequivocally "No Cancer".....when I asked him if he could be sure, he replied "I have felt thousands of prostates....you can be sure"....I'm still hoping of course that this guy with an international reputation is correct and didn't just get a bit carried away and is playing the odds ie: normal DRE, high(ish) free PSA and dropping PSA from first test.

  Obviously the two tests were from different labs, but even allowing for slight change of assay I feel that a 3.2ng drop is quite significant within 2 weeks (assuming no one has fallen asleep at the test tube)

  Regarding the MRI, some posters on another forum (Healing well) that I asked the same question on yesterday have pointed out that it all depends on the test that I was given.....I have now realised that Multi-Parametric means just that....there are various parameters that they can use and if they have used a more basic test (because they were assuming that they were going to follow it up with a biopsy). they may still need that biopsy to check to see what the problem is....(I'm just guessing here of course...I do not know what sort of test I was given....I had some contrast dye and it is a 3T machine and that is all I know 

   I'm trying not to be in denial....The doc the other day did say that if I wasn't bothered I could wait and see if my PSA goes down more in a few months, but now I know there is "something" I have to know....Still hoping that the Prof called it right though.....Thank you for your knowledge, it all helps

     Regards   Tony 

I had a bone scan just in case and the people doing the scan would have known at once. They then put the results on the hospital system and then the consultant can find out. I phoned up the next morning at 8 o'clock and the Secretary told me normal

The next day!!

Yes, I had a bone scan too and got the results back the next day. No need to wait for the doctor. My bone scan came back clear too.

Advice for everyone: Never, never, never (unless it's an emergency) do what a doctor/specialist recommendations especially if it's your prostate that's on the line) until YOU have researched ALL your options. And you decide which option is best for your specific situation. Just as important, know the long-term and short-term side effects. Don't rely on the doctors to tell you the side effectS, if they do, they will minimize or downplay them. Talk to or read posts by men who have had the procedures you are considering.

It's not that the doctors are bad, it just they recommend and believe in what they do but don't usually have enough information on other options to let you know what else is available. And also there is no motivation for them to recommend other options.

Be your own best advocate!

Great Advice. Actually my Doc set me up with a support group of men that had procedures of all types, just so I could discuss the problems that guys had. Perhaps there is a clinic nearby that also has support groups of this same type. Don't reply on internet for support- get it from one on one, face to face, especially if its located in the same place you might have the procedure done.

 

Thanks for the advice, sadly here in the UK we're not as up to date as in the states.....I'm sure that if I were paying privately I could get the biopsy and the results much quicker (I got the second PSA test and the consultation within one day when I paid privately.....Cost me £450.00 which may be more or less expensive than in the US).....Under the NHS I'm just going to have to "suck it up"

  One question if I may? If you only have a small area of Cancer, why are you going for HIFU and not AS for the time being?

   Good luck and regards

       Tony

   

Good question. The reason is two fold. 1st and most importantly, because of the location. It is more likely to spread outside of the prostate so I want to take care of it before that happens. 2nd, there is some concern that the biopsy misses the center of the targeted area and may be a higher grade than biopsied.

Also, AS has its drawbacks. You must get PSA test every 3 to 6 months (not really a big deal) AND a biopsy every 12 to 18 months. I'm not convinced that is healthy or wise for the prostate to be turned into a pin cushion. It actually worse than a pin cushion because they are tearing chunks out. Plus there is a slight chance of needle tracing in which cancer might be released into the bloodstream although there are no studies to confirm this.

It's actually more profitable for a urologist to put a person on AS because then they make money on them doing blood work AND biopsies and eventually still end up doing the prostatectomy. What could be economy better than that for a urologist?

For a 50 year old (+-10 years) when the only options were prostatectomy or radiation therapy which both have severe side effects (ED/incontinence,rectum bleeding, loss of bowel control) AS was the best option, and may still be the right choice for many. But the sooner cancer is detected generally the more options available and better chance for a good and longer lasting result.

Fyi, HIFU is available in UK and usually covered. I know this because I have talked with people over there who have had the procedure.

Hope this info helps.

Hi,Things are a bit different here in the UK, Unless you have private medical insurance (and the majority of people do not) it's the National Health Service for the majority, which is "free" (all British taxpayers contribute) so financial considerations don't really come in to a doctors decision....That's not to say that they don't have their own prejudices for a specific procedure. I wonder why you had a bone scan when your cancer is localised? I was under the impression that if the cancer had not spread beyond the capsule then bones and other soft tissues (ie seminal vesicles) will not be affected......Also could I ask how high your PSA was?

  Thanks

      Tony

A bone scan is routine, even if the possibility of metastases is remote. 

Hi David, I have read that a bone scan if you have a PSA of under 20 is almost never done because of the very low probability of spread.....Maybe this has changed....

This is not correct. The PSA level on its own is not an indicator or PCa. You can have a very low single digit PSA and have a high grade cancer. You can have a PSA of 99 and have no cancer.

do you above any symptoms of frequency or urgency? I am not familiar with HIFU, but want to echo everything else ES wrote.

I recently had a bone scan with a PSA of 8.7 and there are countless stories on here of people who are concerned because they have been sent for a bone scan with a low PSA. I believe it is done because it is a cheap test and rules out those rare occasions where PSA is low but the PCa is aggressive.

Hi David, thanks just wanted to know, I have been reading a book on PCa which states figures from  the Mayo clinic whereby they state that the chances of bone spread with a PSA under 20 is 1 in 306 so unless they feel otherwise they don't recommend....Maybe these stats are out of date, or different strokes etc. Just curious is all.....Thanks 

Bone scans are useful but like PET scans, show only spread that is significant. 

With Low psa you should look at the velocity or the rate of change over a year or two.

I would be more interested in a pre biopsy whome if body PET scan than a nine scan.

 

sorry, my iPad autocorrect is playing up. I meant to say that " I would be more interested in a prebiopsy whole of body PET rather than a bone scan

Agreed - a bone scan will not show micrometastases but I guess it is inexpensive to perform which is why the NHS routinely order them. They are useless as a diagnostic tool but if the scan reveals remote spread then the treatment would not proceed down the surgery/radiotherapy route. 

It seems to me that nothing picks up micrometastases! Except maybe a rise in psa?  What I dont quite get is if psa is 'undetectable' (0.0something) after surgery,clear margins etc, how does it actually rise again? Is it maybe just one cancer cell that got out at some point before surgery, but is not enough to make a detectable amount of psa...then it multiples until it makes enough psa to be detected? Is that how it works?  Some folks have undetectable for years....yet still it can rise! Is that just because prostate cancer cells can take years to grow/multiply?

That, indeed is one of the mysteries of this disease and there is a school of thought which believes that PCa has probably escaped long before we currently think it has. This would explain the many cases where the disease seems to lie dormant for decades only to flare up again. As with all cancers, son of cancer is much more aggressive than the original and we live in hope that the return takes place after something else has come along or we are a ripe old age. It is one reason I don't like the term 'cured'.

I asked my consultant, if PSA rises after surgery, how do we know if it is cancer or just prostate cell 're-growth'?  He said "There is the rub, we simply do not know"!

My PSA sat at 2.4 for nearly 10 years risng to 3.5 towards the end. Yet, a TF biopsy gave a Gleason score of 8 from a suspicious lesion in one lobe. Post-op pathology test showed this to be a Gleason 9.

First post-op PSA was undetectable. Second test later this month. After all the 'good news' in this forum I hope it stays that way. ??

Hi Stewart, I'm only now finding out about the PI-RADS score....wish I'd known about it before, I would have quizzed the doc.....a gleason 9 from a PSA of 3.5 sounds like real bad luck.....I hope that everything from now goes good for you

    Best wishes    Tony

Thank you Tony. Everything from full body scan to lymph node pathology testing, and PSA has been clear. I too hope it stays that way. 

I agree.

Just received my six month post-op PSA results. Still undetectable. 😊

That is excellent news! Best wishes for future similar PSA results.

Thank you Barney. 😎