Improved prostate cancer testing using MRI Scan

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By James GallagherHealth and science reporter, BBC News website 20 Jan 2017

"The biggest leap in diagnosing prostate cancer "in decades" has been made using new scanning equipment, say doctors and campaigners.

Using advanced MRI nearly doubles the number of aggressive tumours that are caught.

And the trial on 576 men, published in the Lancet, showed more than a quarter could be spared invasive biopsies, which can lead to severe side-effects.

The NHS is already reviewing whether the scans can be introduced widely.

Prostate cancer is the most common cancer in British men, and yet testing for it is far from perfect.

If men have high prostate specific antigen (PSA) levels in the blood, they go for a biopsy.

Twelve needles then take random samples from the whole of the prostate.

It can miss a cancer that is there, fail to spot whether it is aggressive, and cause side-effects including bleeding, serious infections and erectile dysfunction.

"Taking a random biopsy from the breast would not be accepted, but we accept that in prostate," said Dr Hashim Ahmed, a consultant and one of the researchers.

Around 100,000 to 120,000 men go through this every year in the UK.

Scanning

The trial, at 11 hospitals in the UK, used multi-parametric MRI on men with high PSA levels.

It showed 27% of the men did not need a biopsy at all."

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  • Posted

    This is what I was always pushing. Now if only my urologist can see the light. That is such good news for the British Men, now they need to do the same here in the USA. I don't want to have a random biopsy and this machine can make sure that I actually need a biopsy. Best of all at that point it can be targeted, so less needle pokes. Those that want watchful waiting this can be a life saver. It is nice to see we have come out of the dark ages when it comes to PC screening. It is horrible the number of men that have to go through biopsies every year. My urologist said if my PSA remains high that I will need a biopsy, I told her nurse I doubt I will allow one on me and she said I don't blame you.

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  • Posted

    Was just discussing this today with a doctoe. He said exactly what is said in the OP. Biopsies are pretty ramdom and may not even take a sample from the spot in question
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  • Posted

    I had a spike in my PSA from a 13 year history. The spike was 2.4 avg to 13 in four months, following a severe UTI. Doctors were saying biopsy...sort of like...of course, you have a high PSA. I demanded  a 3TmpMRI, and, (due to no subsidy, cost me $500), it said I had no meaningful prostate cancer. AND more to the point, a biopsy was not needed. A 12/14 needle stab in the dark to find the little cancer I may have would have possibly caused me serious harm, both short term and long term. Curiously, the PSA Free and PHI test said I had a high chance of prostate cancer. Doctor thought in the end, my BPH and prostatitus was giving a false positive for the blood tests.

    I think it is bizarre that prostate cancer is the main cancer in men worldwide, yet worldwide governments take a view, too expensive to better diagnose. Biopsies are cheap and quick, even though causing many serious side effects, not to mention often missing the actual cancer lesion.

    In Australia, the Government will not subsidise a prostate MRI. They do for several other sites. Maybe because prostate cancer so common, it will cost them too much!! 

    Geoff

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    • Posted

      Which is about AUD500. From talking with other people here getting a MRI, the prices range from AUD450 to AUD750. All said they would do it again, if it stopped the need for a biopsy. 

      The danger is though, MRI will miss some meaningful cancers. For whatever reason, some of the PCa tissue matches that of the patient, making the MRI reading, for them, nigh on impossible. I saw a video of a urological symposium in Australia where a prostate MRI master class was being run. The lecturer put up MRI images, other urologists and radiologists made their call, then he divulged the biopsy results. In most cases the PCa was evident, sometimes requiring a great deal of knowledge to make a determination. Sometime, there was no indication what so ever, and those patients were clear. However, on 2 patients (out of 16) there were no signs of PCa at all...yet the biopsy found 3+4 in both cases. The lecturer then went back to look at their images, knowing where the PCa was, and still could not see it. The lecturer closed the session warning while MRI had made leaps and bounds for prostate imaging, but there were a minor percentage of the population that 'their' images would not be correct, and that biopsies would still be required for some...Ummm, how do you work out who??

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    • Posted

      You have to take it with a grain of salt so to speak. Yea, MRI can miss something , but biopsy that is random often misses cancer. Also the pathologist that reviews the biopsy can miss it as well and often two pathologists will not agree on a slide. So there is always human error involved. I think that the 3T MRI is a great way of finding significant cancers and the ones that it can't may not ever be a problem. One of the biggest issues we face as men is when we get a high PSA reading and what do we do about it. I don't want to have a biopsy soley based on PSA, rather I would like to have an MRI to determine if it needs a biopsy at all and if it does the MRI finding can give the doctor the knowledge of knowing where the tumor is so a targeted biopsy can be done. Also I think that a biopsy can spread cancer through the needle track, so I think we need to be careful when it comes to biopsy. They no longer perform needle biopsies on breasts just for that very reason, so it is logical to assume that it can do the same in a Prostate. So I see the MRI as a life saver and the more it is used the better a technician will get at spotting cancer. So I believe it will just get better with time.

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    • Posted

      Yea, they are close in cost and here in the USA I believe a biopsy costs more than an MRI. So why not have an MRI first. Also if you have a biopsy first then it takes months for the needle tracks to go away, so I read that as a result one would have to wait several months to have an MRI, so in my opinion it makes more sense to have an MRI first, then a targeted biopsy if needed. I think the urologists here make a lot of money from doing a biopsy, but they don't make a dime from an MRI and I think that is why my urologist is pushing me to have a biopsy with a high PSA, she didn't even mention an MRI at all. Go figure.

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    • Posted

      I think that I had my biopsies in 1995 and 1997 in pre MRI days.

      In 1995 my PSA was 5.1 and they said a biopsy was essential.

      Both were negative. The second one caused rather a big bleed and I was kept overnight. A pasing urologist asked why I was there and commented PSA terrorism. Each caused an infection.

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    • Posted

      Craig, the fear of 'tracking' is very high on my list, as to why I am not really interested in a biopsy. For me, unless the MRI says I have a situation that requires active attention, then I do nothing. It stands to reason, punching a hole through your bowel, into the prostate into a group of cancer cells, then pulling the needle out must surely mean some of the cells stick to the side of the needle, which now passes though an open blood supply from the two wounds the needle created. Now do this 12-14 times...that is a lot of highways to your bodies main blood supply the cells can now leak of their own accord.

      Geoff

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    • Posted

      I agree, but I watched a video with a Urologist that said it can't happen because the cancer cells weren't mature enough to live out side of the prostate. When I heard that I about blew my top I was so angry. How stupid does this doctor think we are? They stopped doing this kind of biopsy for breast cancer because it spread the cancer, but for PC it is OK?! I will pass on the biopsy. I told the nurse that if my PSA is high I will not have a biopsy. She asked why. Really? Did she really ask me that? I said for to many reasons to cover right now. I would have a 3T MRI. Non invasive and will show if I have a significant issue.

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    • Posted

      Agree. The less cancer cells wandering about your body the better. I don't care if they are considered "too imature", sooner or later the little sods will be mature and I prefer they be locked away inside my prostate. Though that said, the prostate has a great blood supply, which means these rogue cells can hop a ride anytime, if the cancer lesion has a blood supply.

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  • Posted

    I listened to Dr Ahmed on the radio yesterday talking about this and reflected on the German NHS doctor who referred me for MRI instead of biopsy in 2013,.  I had a BPH diagnosis with a 40cc prostate and initial PSA 8.8.  MRI came back negative for cancer and I avoided a biopsy.  Doctor did order 6-monthly PSA tests though and annual DREs.  Last PSA in Decembr wax 2.4 so I fully agree with Dr Ahmed on this approach.
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    • Posted

      I have to agree as well. My urologist is gung ho about giving me a biopsy if my PSA is high and it probably will be as I have symptoms of BPH. I told her hang on a minute, what about a Pca3 test first? She had nothing to say about that. I wouldn't let them punch holes in my prostate before getting an MRI or pca3 first to see if the risk for cancer is high or something can be seen on an MRI first. Frankly if it doesn't show up on an MRI then I don't think I need to have a biopsy. I would totally trust a high resolution MRI. When I told the doctors nurse that I wasn't ok with a biopsy soley based on PSA, she said I don't blame you. I would be a happy man if I never have to have a TRUS biopsy done.

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    • Posted

      Can I ask if your psa came down naturally Twiglet? My partner (50) has been told he has a 70cc prostate and his psa has been hovering around 7.5, 7.6 for the last 3 months. They think they would like to do a biopsy as his level is high. I assumed that the size of the gland would explain the level and biopsy wouldn't be necessary. 3T MRI showed nothing. I just wondered if the gland is likely to reduce in size naturally or is medication always needed?

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    • Posted

      As I have probably already said my PSA was around 9.8 in 2004 when I had GL Laser on my 75grm prosate..

      It was just under 8.0 in 2013 when my prostate had regrown to 135grm and another laser procedure.  Now my prosate is 55grm and my PSA is only 0.74.

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