How accurate is 3T MRI
Posted , 11 users are following.
Hi Guys, Last time I wrote here a few weeks back a lot of people were kind enough to reply, hoping for some more informsation from people with this experience.....
Briefly: 58 Years old, been referred by GP and having tests at hospital for a sudden rise in PSA from regular 3.1 to 7.5 after a 14 month gap between tests.....Whilst waiting for hospital to get in touch went to a private clinic for a new PSA test with "Free PSA".....Test came back at 4.3 PSA and a free PSA of 23%.....Also had a consultation with private consultant from the clinic who is a well known prof of urology ....40 minute consultation and DRE and he tells me "No Cancer".....
Since then I have been called to hospital, had a cystoscopy (Tests clear)...a CT Urogram and a 3T MRI....They wanted to give me a biopsy, but in light of the lowered test result and the "diagnosis" from the prof I asked my hospital consultant (via his secretary as I have yet to meet him) if I could swerve the biopsy and see what the MRI threw up...He agreed. ....Hospital appointment yesterday to discuss results with urology dept. Doctor called me in, never introduced himself, was a bit stand offish, not unpleasant but very business like, asks why I did not have the biopsy? (he isn't the consultant obviously) I explain my reason and he asks to see the lowered test results, I show him. He explains that the MRI is showing "something" and it is small. I ask him if it is confined to the gland (it is) ....But they need to do a biopsy to see what it is. I say that I thought that a 3T MRI could tell the difference between something nasty, something benign or inflammation....He says that this is not the case, his words were something like: "PSA means nothing, Free PSA means nothing, Scan means nothing only a biopsy can see what this is"
He did say that if I wasn't worried I could leave it until the next PSA reading to see what has happened, but I don't have that kind of personality.
I now feel like I have shot myself in the foot as I have now booked a biopsy for 2 weeks time and the results 2 weeks after that, so instead of finding out yesterday I now have another 4 weeks to sweat before I get a (maybe) definitive answer.......Basically my question is this: Has anybody had the experience where an MRI scan has shown something up which eventually turned out to be nothing to worry about.....I'm talking up to date equipment here guys....
Will post this in Prostate cancer page as well
Thanks in advance
Tony
0 likes, 51 replies
kenneth1955 tony96045
Posted
The MRI will show if there is anything and if there is like most of the guys have said that it will be slow growing. Have it done to see for sure. Don't rush into have anything cut out. I read a artical a few years ago. I want my prostate back. Read it if you can find it. It more problem if you have it cut out. Ken.
tony96045 kenneth1955
Posted
Howard31850 tony96045
Posted
Hi Tony,
I've been in your situation and wish to recommend two liquid biopsies as alternatives to the MRI and needle biopsies. These tests are fairly new and look for biomarkers at the molecular level as signs of developing prostate cancer. One test is called the MiPS (Michigan Prostate Score ) test that looks for biomarkers in the urine. The other test is a blood test called Apifiny by Armune that looks for auto antibodies specific to certain prostate cancers. Both these tests can be ordered by your doctor. I finally stopped my uro from ordering unnecessary needle biopsies by having these tests done myself. The results showed very little chance of cancer ( they are complementary tests ) so I could focus on BPH. If you need further help let me know. All the best. Neil
tony96045 Howard31850
Posted
Hi Neil, I'm in the UK and subject to the National Health service, which is a pretty good organisation, but I'm guessing that the procedures you're talking of would be a bit Hi-Tech/Expensive for them ....Think they're still using leeches in a few places
....I've even tried to find a place that does the PCA3 test, but the nearest place is about 300 miles away....I went privately to get my free PSA tested as the NHS don't fund that one....Don't really want a biopsy but I'm on the conveyor belt now....Just want to get it over and done with and get the results.....I was just concerned that the MRI is showing "something" but the doc says that without biopsy they cant tell what it is...I thought that the 3T MRI was pretty good at differentiating, maybe I got it wrong....BTW I have a large prostate and BPH....whether I have anything more sinister is another matter
Thanks for replying
Tony
Howard31850 tony96045
Posted
I understand - I live in Canada and could not get my doctors ( uro and GP) to accept these new tests so I drove to Detroit and paid cash for the tests myself but that is not an option for you. Still, it might be worth contacting the MiPS people at the University of Michigan and se if they will mail you the kit to do yourself and return. I have a 300 gm prostate and will be travelling to N. Carolina next week for a PAE procedure. The uros here in Canada really trash the PAE and just want to do a prostatectomy on me but I will not let them do it - thanks mainly to the good folks on this forum and their success stories. The 3T MRIs are very good at distinguishing early prostate cancer from BPH but the liquid biopsies are best if available. I had too many TRUS biopsies over the years due to my high PSA. I believe they contributed to chronic inflammation and my growing prostate over the years - but thankfully no PCa much to the chegrin of my uro. All the best to you. Neil
tony96045 Howard31850
Posted
a 300 gram prostate?.....is that the same as a 300cc prostate or have I done the sums wrong?....that is a mighty large prostate....you could get a mention in the Guiness book of records....I've read about the PAE....looks intriguing.....Hope it goes well for you....Just wondered if they couldn't shrink it with drugs....Proscar or the like?
Thanks again for replying
Tony
richp21 tony96045
Posted
Howard31850 tony96045
Posted
Yes 300cc is about the same as 300gm since the prostate density is about 1gm/cc. My saving grace is that I do not have a median lobe - just a long extended prostate along the urethra that is closing it down. Hopefully the PAE will shrink it w/o side effects. i will start a new thread when I get back to report on my progress for others. I took Avodart for the past 5 years and my prostate actually grew from 150 to 300 in that time. I also took Xatral which really helps. Every time my uro did a needle biopsy that was negative he warned me that cancer is lurking in there somewhere but it is too big to hit the regions. Nice guy! That's why I did the liqid biopsies and scored very good. Also my psa is 13 but the psa density is what matters and that is very low. So thanks for your good wishes and good luck to you with this awful disease. Neil
tony96045 Howard31850
Posted
Hi Neil, I neglected to ask the doc what my actual prostate size is....(I imagine the MRI would have a clue)....The guy doing the cystoscopy "guesstimated" it at 50cc The Prof in London said "enlarged", my GP said the same.....I've read that each cc of prostate can pump out 0.1ng of PSA, therefore a 50cc prostate can happily show a reading of 5 and still not be in the "danger zone"....(if there is such a thing)
Good luck with your procedure
Tony
harveybronx Howard31850
Posted
The MiPS test combines the results of T2:ERG and PCA3 markers found in urine. A couple years ago I had the PCA3 test that came back borderline, but within the margin of error to be indicative of nothing. The MiPS test, then, was only offered by Univ. of Michigan and cost $2k US. It, too, is not diagnostic. It can be comforting if it comes back as very low risk for CaP. One would still have to get a biopsy if it comes back as high risk for CaP, and in that case, one would still have to know where to take the biopsy, which is where the mpMRI would come in. So, I figured it's not worth $2k US to have what would be most likely for me, no useful result. Worse, MiPS was not covered by the US Medicare system, whereas the mpMRI was. The choice was obvious. At the time of my investigation, a couple years ago, there was a company in San Diego working on a much lower cost, commercial version of the MiPS test, but a quick online search just turned up nothing other than the U. of Mich. offering. Harvey
viet78904 tony96045
Posted
Hi Tony,
59 with elevated PSA, last few years: 4 something to 9 something to 14.7 & 11 something the latest. Most Urologist will say “biopsy” because that is their work for living (unfortunately I say that).
Due to the elevated PSA, I successfully got the authorization for an MRI.
First MRI (3T) was w/o contrast:
First reader, report included 1) Approx. the size of your prostate. 2) what his interpretation which includes any calcifications, fibrosis, or foci of adenocarcinoma etc. 3) If you have tumor. 4) if you have a BPH. Etc. All these are really depended on the reader (an expert radiologist who read lots of MRI slides in their life time can provide more accurate information than a less experienced ones). In this report there is an area that highly suspicious.
Second reader (I went to get a second opinion) by sending the NRI slide for interpretation: The report came back very similar to the first (I did not send them the report of the first reader). However, the second radiologist suggest to repeat the MRI-DCE with dynamic post contrast enhancement and washout curves to determine more accuracy wherever has suspicious finding.
I suggested repeating the study with dynamic post contrast enhancement and washout curves to determine if one or both of the areas that have now been described have abnormal enhancement and washout curves. He said: PSA is a screening test. It is not specific. You can have a normal PSA and have prostate CA, and an elevated one and not have prostate CA. There is no hard and fast PSA number that says Cancer.
Got second MRI – DCE (3T) as suggested by the second radiologist a month later: I have both the first reader report & the second opinion report. This time the MRI sliders provided better resolution with clearer images for review. Both reports came back with same finding again & similar to the first MRI (no specific find except one area with suspicious). This time the report has a BI-RAD score 4.
Because the word “suspicious” made me wondered for some time & later decided to go with a biopsy. Too bad my Uro only did the biopsy traditional way (not a target biopsy) but he said the 12 points should cover the area identify as suspicious in the report.
Biopsy report came back: 11 out of 12 spots: mainly BHP, one left with the word “suspicious”. Even with biopsy, it still could not detect something but suspicious?? The Uro sent me his congratulation & suggested to take Proscar 5 mg to reduce BHP & retake PSA test again in 6 months.
If the MRI (3T) do not detect any suspicious thing, I will not go for a biopsy. 3T MRI is very accurate if you have an expert radiologist reading it.
I have not use the medication for two months now due to one side effect the I do not like to see “sex reduction”. My problem is very slow urine stream at night. Not strong urine stream (like a teen) in day time but still OK with the age I guess. I am still looking & searching for way to improve this w/o medication.
A friend of mine who is in the bio area said to me that I should never do biopsy. What he said to me is the same as what Richp21 said earlier in this thread “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 probably die with it, not by it. Also if it is positive, there is large % the PCa spreads thru that needle. That the reason we sometime heard someone is Cancer free at one point & all of sudden getting metastasis & die quickly.
Just want to share with you what I have. Hope thing go well for you.
richp21 viet78904
Posted
Hi Vietnam,
Thanks for your long report. Just one thing that I'd like to emphasize. If a biopsy core does come back with a Gleason score that indicates PCa, besides the Gleason score Itself which would indicate the degree of aggressiveness, there are other tests that might need to be done to determine whether active surveillance might be appropriate, or if some procedure might be worth considering. And there are procedures short of a radical prostatectomy that are definitely worth investigating.
viet78904 richp21
Posted
Richp21,
Exactly. There are lots to be learned. I just heard from a friend that there is a new & better way to detect PCa or BPH but still in the final clinical trial (Not biopsy). I will find out.
I see you took Proscar (finasteride) for 6 months. Does it affect your sex life at all?
richp21 viet78904
Posted
Sex life has been very limited recently. Don't really know if what's going on is due to aging (I'm 69), tamsulosin, or finasteride. I did stop the finasteride a couple of weeks ago as it was not helping the LUTS, and things seemed to improve, but can't be certain. The tamsulosin has caused persistent coughing and nasal congestion, and I hoping to find an alternative ... Still working on that.
Would love to hear about what your friend knows.
tony96045 viet78904
Posted
Hi Viet, Thanks for your very detailed post.....Ultimately I suppose it's the luck of the draw who you get to do the procedure, or read the results..."It's the Indian and not the Arrow" as the saying goes.You can only do as much research as possible and do your best to make the right choices......You obviously understand an awful lot about radiology/MRI scans....Not looking forward to the biopsy, but I need to know what this is. Thanks for your kind words
Good luck
Tony