Prostate MRI with and without contrast

I think your internist gave you good advice regarding the MRI for diagnosis/biopsy

A multiparametric 3-T MRI of the prostate is rather like a PSA test. If it says "clear", you can rely on it, like you can rely on a low PSA. There might be micro-cancer, but there is no basis or need for a biopsy, don't worry. But if it comes back bad, like mine, liekhart scale 4 out of 5 for a suspicious area, it is still often just inflammation/prostatitis, like mine was found to be after MRI-guided transperineal biopsy and the HOLEP chips were all clean too. So you can trust a clear MRI.

I agree that you don't need to be in a hurry to do anything about possible prostate cancer. Some urologists will still rush a guy into doing something drastic when the typical prostate cancer is a very slow growing type.

I also had severe BPH symptoms with an enlarged median lobe that was pushing up into the bladder. My original urologist wanted me to have a 'bipolar TURP' for the BPH symptoms (including retention) because that is all that he did at that time. Thankfully I waited until I had done more research and found that there are much better alternatives. I did have to self-catheterize several times a day for several months, but with some good instruction and good catheters, it wasn't really a problem.

After my research I decided to have a Rezum procedure done. It was fast, painless and has an incredibly quick recovery (at least for me). It has been 10 months and my flow is excellent. My PSA numbers were climbing slowly, but since the Rezum procedure reduced the size of my prostate from around 68grams to about half that, my PSA numbers have dropped as well. I am a 66 year old guy in good health.

Hello Gary:

I had a MRI with contrast this past summer. For me, it was necessary to get a good picture of my enormous prostate that took me into full retention. I was able to see the images with my uro and it gave me a good visual of a very large prostate pushing up into my bladder.

My uro also used it to look for lesions before my scheduled SRP. As for a biopsy, my uro felt it was just a stab in the dark considering the size of my prostate (265g) and did not perform it. With a prostate that large, how do you know where to stick it with the needle for sliver samples? I agreed with his logic.

All said and done, I had SRP done in August. Mass removed was sent to Pathology and all was benign. Now I no longer have retention and pee like a young man, and if course, no cancer.

Dave

Hi Gary - I have severe BPH and have had 2 mp3T-MRI with dynamic contrast. This is an extremely important screening test for you to get for prostate cancer. This scan will show any suspicious lesions which will be rated on the Pirads scale from 1 to 5 depending on the risk for them being cancerous. If the value comes back at 3 or greater than a trained urologist or interventional radiologist (like Dr. Karamanian) will do a targeted needle biopsy on the lesions to check for cancer. This approach is infinitely better than just doing a blind needle biopsy of the prostate which usually 12 or more cores and is very indefinite if negative.

PSA values don't mean much if you have BPH. Rather compute your PSA density (PSA/prostate size in cc) and if less than 0.1 that is good. Also get your Free PSA measured at the same time as your PSA and if the value is > 18% that is good too. Finally the old reliable DRE is good because your uro can feel any lesions near the surface which is where most prostate cancer resides. Good luck. Howard

Gary,

after AUR my PSA was up to 9. The urologist wanted to do a biopsy. I refused and had an MRI. Dr K considered it clean, but also

admitted that it was not 100% for

sure. But, then what is? The uro

put me on Tamsulozin which I took for 2

weeks and stopped again. It gave me

retro in no time. Took a K4 test which showed high risk of prostate cancer. The uro insisted in biopsy again and I refused

again. Took another PSA test and it climbed to 11. The uro insisted again in biopsy and again I refused. Urolift was not an alternative due to large median lobe. 8 months after my AUR event i had a procedure done (Rezum and PAE) which was

a real success for me. 6 months later I had another PSA test done and it turned out fine. I am 65 now and do well. i think I have been very lucky indeed. Good luck to you!

Hi Gary,

I had a 3T MRI with contrast after my PSA kept climbing. My PIRADS score came back 4/5, which was concerning. I then had a targeted biposy which came back negative.

One thing I would recommend is to not leave the imaging center until the technician verifies that they got a good scan. I apparently fell asleep during the scan and my body twitched a bit. They didn't look at the scan until after I had left for home, so I had to come back a second time and do it all over again.

Rich

Hi Gary,

I had bph with a median lobe pushing up against my bladder, my average psa was 2-3, but once at 5 after a fall, I learned psa is just a guide as some can have a high psa with no cancer others can have a low psa with cancer, because I chose to have FLA to solve my bph median lobe Dr Karamanian in Houston Texas asked me to have an 3T mpa MRI as anything less than 3t will not be accurate enough to see the bph and possible cancer I asked him if I can have it without contrast and he said yes, I had the 3TMPA MRI done here in New Zealand the results said there is a highly suspicious area which they said was pirad 5 but slightly different whatever that means, so Dr Karamanian down loaded the mri and results and suggested it would likely be not cancer but inflammation, I asked him why he explained mri technicians who write the results have training that allows them to categorize but not always able to distinguish differences, now came the time to decide on a biopsy I was very reluctant to have a standard prostate biopsy which can have about 12-16 needle biopsies from one direction and if no cancer is found they then take another 12-16 biopsies from another angle, my personal thoughts and fears were if I had prostate cancer could all the biopsy needle bleeding spread cancer to elsewhere in my body rather than keep it inside the prostate and live longer, anyway he recommended a biopsy of the suspicious area but to be done by a highly skilled urologist with ultra sound guidance as I live in NZ with limited options, I chose to limit the biopsies to 3 needle biopsies -my own decision(via the anus rather than under the scrotum as I found google said that way there less risk of spreading cancer), at that time about 1 year ago Dr K aramanian said MRI scans although very helpful are not able to guarantee 100% discovery of all cancer and blind prostate needle biopsies can sometimes find cancer that an MRI might miss but being blind biopsies they can also miss cancer (I did not think I had cancer so took a chance with just a 3 needle biopsy of the suspicious area only)

The biopsy result came back as not cancer but inflammation just as Dr Karamanian said, he did the FLA it was amazing I could pee easily with no more flow restriction and finally get a good nights rest and no known side affects at all it is absolutely Brilliant!, Dr Karamainan also uses an anti inflammatory prior to surgery on all his patients to help reduce the chance of cancer from surgery, have a chat with him he is outstanding, a very decent human being that genuinely cares , extremely knowledgeable and helpful, hope this helps all.

Hi Gary! Yes, I had a multi-factorial or spectral MRI (I think it goes by different names) when I refused to have another prostate biopsy. In my first biopsy they pierced me 40 times and I bled for 3 1/2 months but they found no sign of cancer. The MRI found a low grade suspicious area for cancer. My Uro wanted to do another biopsy and at first I refused. He then made it sound like it would be a single piercing with a thinner needle and a very simple procedure, but when I got in they did another 16 biopsies. I bled for just over a month. They did a "fusion" biopsy where they fused the MRI image with the ultrasound image to take accurate samples of the suspicious area. They diagnosed me with a Gleason 6 cancer and told me to simply watch and wait. I subsequently had a self-referred PAE procedure which the doctor targeted the area of the cancer. I am ready to have another PSA to see if he got it. I am much relieved from my nighttime visits to the bathroom, going from 5 to 7 times a night to 2 or 3 times a night. The MRI was great, no problems, and much better than any biopsy. Medicare paid for it. I am 71.