How accurate is 3T MRI

Hi Pepasan, I'm new to all this although I have spent the last 5 weeks since my raised PSA scare doing a lot of research....I'm hoping for something benign of course but thought that 3T MRI could tell the difference, hence my question....Don't know if I could do the active surveillance thing....you have to have that kind of mindset I guess....Good luck for the future....and thanks for the reply

       Tony

Hi Tony,

The answer is yes. I had a continually rising PSA over the years. Years ago I had had 2 biopsies, both negative. PSA kept rising to 9.7. At this point I found out about 3T MRIs, and had one. It came back with a very suspicious area, so of course arranged for a third biopsy, a targeted fusion biopsy where they use the MRI to guide where the needles go. The biopsy came back negative. With that said, even if your biopsy were to come back positive, a large percentage of PCa is very slow growing, not aggressive, and not something to be overly worried about. You would want to thoroughly educate yourself so that you could make an informed decision about how to proceed. You really can't trust the uros to give completely unbiased and thorough guidance. This forum is a great resource, and there is another one that I found to be incredibly helpful. Also, a few excellent books. I can post the name of the forum and the book titles here if you or anyone else is interested.

I just saw your reply to Pepasan. If there is PCa, please educate yourself before ruling out active surveillance. It's not appropriate for all situations, but there is a huge amount of over-treatment of PCa with the possibility of very detrimental side-effects.

 

Hi Rich, thanks I remember your reply from my previous post.....I am hoping for a likewise negative result, but thanks to my needle shyness I now have to wait another 4 weeks for a result....I know you have read the Mark Scholz book and are an advocate for AS......at 58 I don't know if I could do it.....I fear I would always be concerned that whatever it was was biding its time before becoming aggressive and waiting to ambush me

Hi Tony,

      I understand your concern and would absolutely support you in whatever decision you think is best for you. I'm not really an advocate for AS, but an advocate for not taking any uro's declarations as to what is best for you as definitive, and for taking charge of yor own care and researching things thoroughly.

Have you read the Mark Sholz book? There are two others that I found

very helpful:

 Prostate Cancer Breakthroughs 2014: New Tests, New Treatments, Better Options: A Step-by-Step Guide to Cutting-Edge Diagnostic Tests and 12 Medically-Proven Treatments  by  Dr. Jay S. Cohen

 You Can Beat Prostate Cancer: And You Don't Need Surgery to Do It  by Robert J Marckini

  And as I mentioned, there is another forum on another website that is specifically devoted to PCa. I found it very helpful when I was researching PCa in between my MRI and getting my third biopsy results.

   

Rich

Hi Rich, thanks for the book ideas, I'll check them out....I seem to have spent the last 5 weeks doing nothing but researching PCa. starts to get a bit depressing after a while...I am an OCD personality so find myself obsessing about this stuff all the time....Not Good....I've checked a lot of websites and forums Healing Well You are not alone etc....But always open to more ideas

    Thanks again

Ah yes, there can be a fine line beween OCD and being thorough. With me, it really boils down to whether I'm being tense about something, or just recognizing that I need to be my own advocate in the broken health care system in this country (USA).

The website I was on had a very knowledgeable frequent poster. The depth of his knowledge and the time he spent in correspondence with me and many others was quite amazing. Another universe from the 10 or 15 mn that uros schedule for each patient here my neck of the woods.  I'll put the web site info in another post. If the moderator blocks it either for a while or permanently, please PM me if you'd like the name of it.

Whoops. I posted the general website, not where the forum is. The general website looks very helpful, but I haven't spent time there. I will post the link to the forum in a seperate post. Looks like it will be all be reviewed by the moderator.

Hi Rich, You may be talking about the healing well website and a guy called Tall Allen?....or maybe not....I was thinking about going and asking my question there....but I feel that maybe I should just drop it and get on with my life for the time being....feel free to give me the site details if you dont mind though....Thanks again

    Tony

No, not that one. The second post that the moderator has on hold is the link to the forum. I think the moderator usually gets to it withing 24 hrs, and I think he won't have a problem with it. If you'd like the info sooner, PM me and I'll get it to you.

I also have a large prostate, and as mentioned, an MRI that showed a very suspicious area, but subsequent negative biopsy. Best guess is that my elevated PSA is due to the large prostate.

Thanks Rich, I'll be glad to have a look at your forum....I hope you are right about your MRI (I thought that they were cutting edge and could "see" anything)....I'll keep my fingers crossed for you if you'll do likewise 

   Tony

Looks like the moderator hasn't gotten to my two posts yet.

Not to cause you any more concern, but it's my understanding that all diagnostic methods, including biopsies, can have false negatives. The MRI can actually see part of the prostate that a biopsy can't reach. The MRI can have false positives (that's me and hopefully you!!!). Along the same lines, if a biopsy returns a sample with a Gleason score that indicates PCa of some degree, that evaluation is to some extent subjective. I think that sometimes it's a good idea to get a second opinion on the Gleason grading. I had lined up John Hopkins for a second opinion if mine had come back positive. If you have a biopsy and want to have the option of a second opinion, make sure that the sample tissue is available to you for sending to another lab.

I've deleted the posts with links so users can use the Private Message service to ask for them if required. However, I have noted the sites 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 Rich 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

The moderator has deleted my posts with the links. See his reply about that. Haven't done a PM before .. I'll see if I can figure that out and send the links to you that way.

Hi Rich,

Just click the envelope under the relevant user's name.

Alan

Thanks Alan.

Just sent you a private message with the links.

I'm presuming you must've had a multi-parametric MRI (mpMRI) that can illuminate suspiciousluy cancerous areas of the prostate.  I had my mpMRI in Jan, 2015, after my PSA shot up from 8 to 14.  If suspicious areas are noted, then only a biopsy (at least, then) can determine, for sure, if the suspicious area is aggresive CaP or not.  The mpMRI does not detect indolent CaP.  In my case, no suspicious areas were found.  A few weeks later, my PSA dropped back to 8.  My PSA has gradually gone from 6 to 8 in 17 years, with two negative, traditional random core biopsies (TRUS)!  However, there are two technologies for positioning the needle that performs the biopsy.  One is image fusion, where the mpMRI image is overlaid on an ultrasound image of the prostate that can be done in the urologist's office.  The other is where the biopsy is performed inside the same MRI machine that was used for the mpMRI (MRI-guided biopsy), which is more accurate, since an image overlay using two different kinds of machines at two different times cannot be perfect, and the prostate is also deformed by the biopsy needle, itself.  However, all of this techology is advancing, although 3T MRIs that can perform both the multi-parametric MRI and the in-bore guided biopsy are still probably not widely available.  In January, 2015, when I last checked, before I had my mpMRI, there were 5 such facilities in the U.S.  And even for the in-bore biopsy, a remote-controlled biopsy needle was not yet commercially available, as far as I was able to research.  Note that the kinds of materials that can be inside the bore of the MRI machine without affecting the image are very limited.

And by now, there may be other methods of positioning a biopsy needle.

Hi, As far as I am aware the machine was a 3T mpMRI (I'm on a steep learning curve here).....I deferred on the biopsy because I was hoping that the "all seeing" machine would show nothing.....unfortunately not the case....Doc at hospital says I need a biopsy to see what the "something" is.....hence my question...I have had all kinds of different replies and it's quite confusing....I have people saying that the machine can only pick up on suspicious areas (as in my case) but wont know what they are ie benign, maignant, inflammation etc. and others who say differently....Just going for the standard 12 needle TRUS...I mentioned targeted biopsy to the Doc and he just said that this is small but they'll know where to look....(is that good enough?) who knows?.....It's in the lap of the Gods I guess

I'm in the UK so at the mercy of the NHS who to be fair have been good (so far)

  Thanks for the reply

My opinion is that the random TRUS (whether 12 needle or 16 needle or 30 needle) is an obsolete technique that no longer makes any sense when the mpMRI will tell the urologist precisely where to look.  Random is random, hit or miss.  Why miss when you can see where to look?  There may be more advanced techniques with ultrasound now that enable the biopsy location to be not random, but I have not researched that, lately.

I don't understand the following sentence you wrote:  "I mentioned targeted biopsy to the Doc and he just said that this is small but they'll know where to look."

How will s/he know where to look?

Harvey, If I knew the answer to that I'd be doing my own biopsy .....I mentioned a targeted biopsy to the doctor and he kind of shrugged it off....(maybe he thought I was saying targeted in the sense of one or two samples)....I'm guessing that if I or an insurance company was paying through the nose for private treatment I could hit them up for all kinds fancy schmancy treatment, sadly this is the National health service.....I'm actually amazed that they have given me an mpMRI in the first place, rather than just a "blind" TRUS biopsy.....I got more info from the nurse who made my appointment for the biopsy, when I queried as to whether the doc doing the biopsy would "know" where to look, she said that of course they would use the information from the MRI scans....The doc has already told me that what they are looking at is small (albeit very accessible)....just hope they don't miss it.....soon find out I guess

    

Tony, at least the doc knows there is something there to find from the mpMRI, so if "it's" missed in the biopsy the doc will know that it's missed,  because the pathology report will not indicate any structural differences in the cells.  If "it's" found in the biopsy, those cells may still turn out to be benign.  Good luck!  Harvey

Thank you....It's appreciated

    Tony

Tony,

I would listen to the nurse about that in your post. Most Uro use traditional method of biopsy (standard biopsy) which will consist of any where between 6 to 14 samples taken in a standard map. That was what my Uro siad when I asked the same question with MRI result. Even with target biopsy, the doc would use MRI guided when they perform the procedure regardless of the previous MRI you had. The MRI scan is used only for the purpose that if a biopsy is needed. Hope it helps.

Hi Viet, thanks for that.....I've been reading back through your posts on this thread....Excuse me if I missed it but what was the outcome of your "suspicious" area?....or are you just keeping an eye on it?

   Thanks

  

In my previous post I should said " I would not listen to the nurse...".

OK, it is funny that the result from my first biopsy (I did this biopsy because the MRI said a " highly suspecious " at one location) came back with "suspecious" too. "Wait & Watch" now. Will check PSA again in 6 months & see. If there is a sign, I will probably request another MRI to scan (absolutely no biopsy unless the next MRI shows something). Biopsy is the LAST resource. I am checking the polaris testing & see if it's an option, if needed.

Hi Viet78904, You are a braver man than I.....The hospital doc said I could do likewise, if it wasn't bothering me....just recheck my PSA in 6 months time......Well Doc, it WASN'T bothering me until you told me that a £2m piece of technology has just spotted something "suspicious" within my prostate.....Now it IS bothering me.....I don't have the watch and wait kind of personality.....Hope it all works out for you

   Best wishes

Perhaps I'm not understanding what viet wrote.  A biopsy shouldn't provide a "suspicious" diagnostic.  It should provide a definitive diagnostic, or maybe a precancerous diagnostic.  If the pathologist can't figure out what it is, get a second opinion.  I had a second opinion for a biopsy a long time ago that first came back as "atypical small acinar proliferation (ASAP)."  The second opinion was that it was benign, with an explanation for why the first opinion likely went wrong.  If an mpMRI indicates a suspicious spot, I would think it's essential to perform a biopsy of that exact same spot, since the mpMRI does not find indolent CaP, only CaP that's more aggressive than indolent.  So, in case of an mpMRI that finds a suspicious spot, there's nothing to wait for except, perhaps, potential calamity.  If it were me, as with tony, I'd want to find out immediately if it's a potential calamity or a benign aberration, rather than wait to see how aggressive it is as it possibly takes over the prostate.  

It's my understanding that a mpMRI can return a false positive, showing a suspicious area that returns normal in the biposy.

Hi Viet,

    I believe there are two types of MRI guided biopsies. The first is what you mentioned where the biopsy is performed in an MRI unit. This is not so common in the USA. The second type, which is what I had, takes the MRI, and at a later time fuses the MRI data with an ultrasound unit that guides the biospy.

Rich:  Yes, an mpMRI can return a false positive.  There is a great review article on the U.S. National Institute of Health website, entitled:  "False positive and false negative diagnoses of prostate cancer at multi-parametric prostate MRI in active surveillance," by Jeffrey S. Quon, et al, published  23 May 2015.  If you search for the title, it comes right up.

This is the link:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519810/pdf/13244_2015_Article_411.pdf

Harvey

Rich, Yes, an mpMRI can return a false positive.  There is a great, comprehensive review article on the U.S. National Institute of Health (NIH) website: "False positive and false negative diagnoses of prostate cancer at multi-parametric prostate MRI in active surveillance" by Jeffrey S. Quon, et al, Published online: 23 May 2015.

If you search on the entire title, the article comes right up.

Harvey

Thanks so much. Got it. I'll read it soon.

Rich,

Every test we do can return false result at some point in time. I did not have just one MRI, I had two MRIs (3T). The second one is recommended by the second opinion doctor that included everything I suggested. The second one did not however identify what the "suspecious" seen in the first MRI is. Went on with the biopsy & came back the same "suspecious".  If all three methods did not detect (or identify) a Pca, it's likely no Pca.

On another hand, if keep trying to find out what it is by biopsy, there are three issues: 1) Damage (or weakening) your prostate  & 2) Odd (unexpected things) may happen, & 3) possible spreading if it's positive.

Been around lots of coworkers, often seen or heard people die of metatasis (in a short period of time) after the doctor done the treatment & declared "cancer free" patient. Lots of them find out that the cancer came back after the treatment. So we need to make a wise decision for ourselfs.

Viet,

Did you have a multi-parametric MRI (mpMRI)?

I don't understand how a biopsy can come back as "suspicious."  The biopsy will determine what the suspicious cells are.  The problem with getting a biopsy of an area that is suspicious from an mpMRI, is locating that suspicious area.  That is hard to do unless the biopsy is performed at the same time as an mpMRI, within the bore of the machine, itself.  (There are very few of those 3T MRI machines in the U.S. set up to do that) That way, the biopsy needle can be directed at the suspicious area in real time, which would be an accurately targeted biopsy.  

If the biopsy is done on an ultrasound machine, the so-called TRUS-guided biopsy, then the mpMRI image that shows the suspicious area must be somehow overlaid on the ultrasound image.  That can be done either with fancy software, so-called Fusion Registration, or by just having the urologist look at both and attempting to mentally overlay the images, which is the so-called Cognitive Registration (CR) method.

The article I mentioned on the US NIH website in one of my previous posts explains all of this in gory detail:  "False positive and false negative diagnoses of prostate cancer at multi-parametric prostate MRI in active surveillance"  by Jeffrey S. Quon, et al.  An Internet search on the title will easily find it.

Harvey