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Visiting urologist for first time.

Posted , 5 users are following.

barry24668
barry24668

Hi

I'm a 62 year old male and have had a couple of PSA tests done recently (12.4 then 10.5).

I'm off to visit my Urology department in Hospital in Devon tomorrow, taking a urine sample with me. I'm expecting a DRE and possibly followed by an MRI scan.

I've been reading on this forum that at 3T MRI scan is the better one as it's more detailed and can pinpoint exact points where a further (less invasive) biopsy (if needed) can target those points.

I don't think my local hospital have a 3T MRI scanner and probably have a 1.5T MRI scanner which seems to give a lesser result.

Does anyone know if I can delay my scan and asked to visit another hospital (in Bristol) where they may have a 3T MRI one ? Does the NHS just give you a chance to have 1 scan, so I may not be allowed another ?

I'm thinking if I have a scan (1.5T scanner at Barnstaple NHS) the biopsy that follows will be more invasive than the more details one 3T and then having a more targeted biopsy ?

Does anyone have any feelings on having the different types of MRI ?

I'm also wondering if I should look into a bone scan (should the need arise) as the recent

news of Bill Turnbull on the television sadly developing the cancer spread to his bones. 

Thanks for your help and any advice you can give me.

 

0 likes, 16 replies

16 Replies

  • Pepasan
    Pepasan barry24668

    Posted

    For some 15 years I've been through a conventional course of psa testing, monitoring, psa testing, biopsy, monitoring, scan, psa testing, monitoring, biopsy, monitoring, scan, psa testing and monitoring. Low grade cancer was confirmed at the second biopsy. No treatment so far. It has at times been an anxious journey, but none of the conventional tests have been a problem. Every case is different, but I've never had reason to doubt that the good old NHS would do the right thing for me.

    If you had symptoms like Bill Turnbull, then don't delay anything - treatment will undoubtedly be likely and the earlier the better. However, many of us have no symptoms and have only discovered there is a problem through testing. You don't say how you started on this psa testing road, but if it was just as a routine rather than due to painful symptoms, I see no reason to expect any special extra scans or tests.

    • barry24668
      barry24668 Pepasan

      Posted

      Hi, Many thanks for the info.  I have no symptoms but due to friends having been diagnosed problems but too late and the recent press coverage I wanted to be safe rather than sorry.  Having read most of the forums, I am trying to be prepared in advance and ask as many questions as possible on my first consultation.     Many thanks for the advice. 
  • anne05147
    anne05147 barry24668

    Posted

    Hi Barry, my husband is same age as you and 2 years ago had a PSA of 10 which has fluctuated slight up and down but last one was 11.  He had an MRI at one hospital that looked suspicious and then was offered the rectal biopsy but wasn't sure, so postponed as wasn't confident about the hospital, (voted 2nd worst in our area)  I asked for a referral to another hospital/2nd opinion from our GP and we were prepared to pay privately for a new MRI l and we then went to another hospital where he had an MRI with contrast in a multiparametric 3T scanner with contrast which showed no evidence of cancer.  He was then offered a transperineal biopsy which he has for the moment declined and is having regular PSA testing with a view to have the biopsy if his PSA increases.  

    He also had a rectal ultrasound which showed enlarged prostate.  He has the DRE etc.,

    All best wishes Anne

    • rolf61809
      rolf61809 anne05147

      Posted

      I put off an MRI for 4 months because no one in Ohio offered the trans perineal one. Finally settled for the transrectal even though the incidence of infection is so much higher. My urologist denied that and that was the point where he told me to stay off the internet.
    • barry24668
      barry24668 anne05147

      Posted

      Hi Anne

      Many thanks for the extra info. Yes I was a little worried that my consultant seemed very keen on giving me a biopsy after my MRI scan, no matter what the MRI scan discovered.

      Although I did feel that the process with the consultant was very organised and a quite a quick process, having offered me an MRI quite quickly

       Having read up on the web about the new 3T scanner being equal to going from an old camera picture to an iPhone picture quality  taken today and showing areas a millimetre in size that the (15 year old) 1.5T MRI scanner can miss,

      I am now in the process of another referral via my doctor to visit Bristol Hospital Urology dept which there own publicity says they are one of the best in the South West,  and hopefully I can insist

      on the 3T scanner, although I'm not sure how insistent I will have to become ?

      I do not feel any symptoms and have nothing metal inside or outside of my body.  I go to gym classes most days and I am of average build 12 stones in weight, that's partly the reason why I do not want to rush into a biopsy and get further complications from that if a biopsy is not necessary. My DRE showed nothing and the consultant said my prostate felt normal but that does not indicate anything. 

      It seems to me that forums like this one are the best for getting more information that you can then ask about when visiting the hospital.  Thanks Anne, I will have a look further at the NHS website.  It's a shame that its not easier to find somewhere on the web listing where NHS hospitals have a use 3T MRI scanner.

      I am thankful to my doctor in allowing me a second referral.

      Good luck and thanks everyone for your recommendations. 

       

    • anne05147
      anne05147 barry24668

      Posted

      Hi Barry

      ?I know the difficulty about 3T multiparametric scanner.  I phoned the scanner department and asked what type they had and they didn't know.  Then I found one we could have done privately but then the other hospital offered to do it.  If you have a good consultant you shouldn't have to ask too strenuously but it is important to ask, otherwise they might not do one.  If you don't ask you might not get, so in a situation like this it's best to put the embarrassment of being sounding a bit pushy to one side.

      ?Hope all goes well and you get what you want done.  This is a collaborative approach between you and your doctor or it should be.  It's your body at the end of the day.  Hoping you get a good result.

      ?Anne.

  • barry24668
    barry24668

    Posted

    Hi Anne

    Many thanks for the info.  Yes I am going back to my doctor and asking for a second opinion at Bristol hospital as they seemed to be better than my local hospital who don't even have an onsite MRI scanner and routinely used a 1.5T scanner (at another hospital) followed by a biopsy as a matter of routine.  Hopefully Bristol will have a 3T scanner and give me the option of whether to go ahead with the biopsy or not, thank you again.  Good luck with everything. 

    • rolf61809
      rolf61809 barry24668

      Posted

      And I've mentioned this several times on the forearm but different Radiologists reading the MRI can come up with vastly different conclusions. My local radiologist reading as four and five while the radiologist at the Cleveland Clinic read it as two and two. I did finally decide on a transrectal MRI 2 weeks ago and the score was 0. I'm hoping that it was just the 4-5 radiologist that was full of you-know-what and not the Doctor Who did the MRI.

    • anne05147
      anne05147 barry24668

      Posted

      Hi Barry

      from the nhs choices website.

      ''The NHS Constitution gives people living in England the right to choose where to receive treatment. You have the right to:

      choose your GP surgery, unless there are reasonable grounds to refuse, for example you live outside the area that the surgery covers

      make choices about your NHS care, and to receive information to support these choices

      This also means you can choose the organisation that provides your NHS care when you're referred for your first appointment with a consultant. So if your GP recommends that you see a specialist, you can choose where and when to see them.''

      ?However, you do not have the right to a second opinion, which I initially thought you did, but there is still a possibility that your GP will still refer for one, as our GP did.

      If you go to the website NHS choices it will explain in more detail.  I didn't past the link as sometimes it gets moderated.

      ?All best wishes that you get one.  Anne

    • barney34567
      barney34567 barry24668

      Posted

      While 3T provides far better images than 1.5T, the most important thing is to find a radiologist that specialises in prostate scans reporting.

      As my excellent urologist said "better a 1,5T scan reported on by a prostate expert than a 3T scan reported by a generalist radiologist.

  • rolf61809
    rolf61809 barry24668

    Posted

    My urologist at one point told me to stay off the internet. He wanted to do a biopsy and I had to fight to get a 3T MRI done instead of the 1.5 T MRI they were ready to give me. And if I hadn't spoken up I wouldn't have gotten an MRI at all.

    And I'm glad I did. I'm in the US though so I can't speak to how the NHS works. There is also a 4K test that can do to show the likelihood that you have any cancer. Again I don't know whether it's available through NHS or not.

  • barney34567
    barney34567 barry24668

    Posted

    Have you had any medical treatment that resulted in metal being placed in your body?

    For instance, screws, coils, clips etc as his would make a 3T scan trickier.

    In answer to your question: 3T's images are FAR clearer than 1.5T, bu I had a 1.5T

    mri which clearly concluded: PIRADS 4. This meant I have a VERY good chance of having

    a nasty PCa.

    The biopsy hat followed confirmed this.

    The most detailed and safest biopsy uses ultrasound/mri images and is called TRANSPERINEAL

    and results in less instances of sepsis.

    After a biopsy and before any treatment begins, is the time to get a bone scan. Ideally one that targets PCa

    on he bone. I recommend the 68Ga-PSMA scan, which is perfect for this.

  • barry24668
    barry24668

    Posted

    Hi, I read your earlier at length description of your biopsy operation, thank you for that, it was of great interest and very detailed.  Just one question, I see you had a 3T MRI scan, I am going for a second opinion in Bristol NHS and after phoning them they mentioned they use the 1.5T MRI scanner but do have a 3T machine.

    Did you have to insist or fight to have use of the 3T MRI scanner.

    Best wishes

    Barry

    • barry24668
      barry24668

      Posted

      Hi. rolf61809

      The above question regarding the 3T scanner is intended for Rolf61809

      apologies but I do not have your name.

      Thanks

      Barry

    • rolf61809
      rolf61809 barry24668

      Posted

      Well at first they just wanted to do an ultrasound transrectal biopsy. Educated myself on the internet and found out the fusion biopsy was by far preferable. I requested an MRI and found out they were planning on using a 1.5 MRI. So yes I did have to raise a stink when I found out that they also had a 3t mri machine which I had found out was by far preferable to a 1.5. then as I have said my Bozo of a radiologist locally rated me as P I rads scores of 4 and 5, where has my second opinion radiologist at the Cleveland Clinic only found two and two. And oddly enough I couldn't get the Cleveland Clinic to do a Fusion biopsy because their scores were so low. So a couple of weeks ago I finally had the fusion biopsy locally and they found 0 nothing. So I'm inclined to think that my local radiologist was an idiot because the Cleveland Clinic found much lower Pi rad scores. At least I hope so because the other possibility is that the urologist who did the fusion biopsy missed the areas indicated by their MRI. If you are in Britain I don't know what their Protocols are but by all means insist on getting the 3T if you can.

    • barry24668
      barry24668 rolf61809

      Posted

      Hi, many thanks for the helpful advice.  It seems that we all have to fight our own case to attempt to get optimum treatment for ourselves, which I guess is probably down to costs.

      I will go armed with lots of info when I visit my NHS hospital in Bristol in a few weeks time.  Many thanks again and good luck to all.

      Barry

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