What to expect in a 3T Prostate MRI report

I have BPH which was beginning to cause nighttime retention problems. I started dutasteride and alfuzosin about 8.5 months ago. My PSA hasn't come down as much as the uros would like. Also, I would like to get a good estimate of my prostate size. You know uros; they can't wait to stick an oversized probe in one of our orifices. Let the prostate MRI indicate whether or not I need a biopsy as opposed to PSA.

3T mpMRI Prostate Results - UPDATE

So I had the 3T mp MRI for the prostate (MRI) on 5/9/2019. Here is a recounting of the experience:

1. I arrived and signed in. The procedure scheduled was a 3T multi-parametric MRI using a pelvic coil. I did NOT have a FLEET enema prior to the procedure. I brought my blood work results for creatinine and eGFR (recommended if gadolinium contrast is to be used). I was very surprised when the check-in person said that they no longer require these blood tests. The website said they were required. I filled out the MRI screening form and then waited for about 20 minutes. It was disappointing that the website directions did not correspond with reality. The website also said I need to have a FLEET enema, but when I called prior to the test, they said I didn't.

2. I then changed into the hospital gown and was taken to a nurse to have just an IV tube put in my arm; the IV tube would not be connected to fluid until I was in the MRI machine.

3. They put me in a waiting room. A couple of minutes later a really hot woman came to wait in the room with me (this was by far the best part of the experience). Although we chatted for a few minutes, I didn't dare ask why she was getting an MRI.

4. I was then taken to the MRI room. I had scheduled the wide-bore machine, but they had problems with that machine that day, so I had the MRI done in a regular bore machine. I didn't really feel claustrophobic.

5. They attached the IV saline solution (not Dotarem) to test the drip. It was very painful and they determined that the IV tubed had moved out of the vein. It was removed and inserted into my wrist (also painful at first).

6. They tried to make me comfortable and I thought I was. But I really needed more neck support during the scanning as it was aching. My recommendation is to make sure that you are comfortable everywhere, because you are supposed to remain perfectly still for 5 minutes at a time.

7. I believe around ten scans were run mostly for 5.5 minutes at a time although a few were only 3.5 minutes.

8. BY FAR the most difficult thing was keeping absolutely still during the scans. The technician told me afterwards that she could tell I was moving (and even reminded me once during the scans not to move). I was surprised when she told me that. I did have two spasms in my hamstring. I was also moving my right forefinger on purpose at times (which I figured would not affect the scan). When she mentioned my moving, I responded with "what about breathing". She said it does impact the scans somewhat. There were a couple of times I took deep breaths, probably because I was in the more narrow bore. The technician said that the scans were probably good enough to be read by the radiologist (the radiologist confirmed this later).

9. Near the end, they ran a Dotarem (gadolinium) contrast drip through the IV. I barely noticed it.

10)The MRI scans took about 50 to 60 minutes in total. Afterwards I got dressed and went to the waiting room.

11. I was able to get my images immediately from the radiology reception desk. Only took about ten minutes. However, there was no report on the results because my MRI was an after-hours MRI (scheduled for 5:30 PM). By now it was 7:05 PM.

NOW THE RESULTS:

About a week later I received the written report with a new disc of the images (which now included the written report as well).

-Prostate volume - 103.1 cc

-PI-RADS v2 score equal to 2

-No suspicious lesions

-Seminal vesicles - normal

-Lymph nodes - normal

-Bones - no suspicious lesions in the field of view

-Bladder - normal

-Rectum - normal

And that was all that was reported despite my specifically requesting that descriptive comments about the median lobe and bladder be made. I e-mailed the head of the department, who it turned out was the one who read my images. He responded the same day with the following (which he added to my report):

" Images were again reviewed on 05/15/2019 by Dr. XXXXX. Three additional comments are added to the report. 1) The quality of the study is deemed adequate for interpretation. 2) The prostate is diffusely enlarged, without a distinct "middle lobe". Because of the extensive benign prostatic hyperplasia, a smooth bulge is seen at the bladder base, measuring approximately 0.8 cm. 3) The urinary bladder is minimally trabeculated, without diverticuli. No focal lesions are identified."

All in all it was a good experience, even though I had to keep on top of things. Although I didn't actually talk with the radiologist, he has been very good at responding to my emails (both before and after the MRI) on the same day. Having questions answered in writing provides a good record.

I'm glad that my cancer risk is very low. However, I am somewhat dismayed by the prostate volume results. Here are prostate volume results that I have had over the past year:

8/09/2018: 145 cc measured by transabdominal ultrasound (prior to dutasteride)

8/20/2018: 98.6 cc measured by transrectal ultrasound (taken to compare with TAUS measurement)

1/10/2019: 70 cc measured by TAUS (after about 5 months on dutasteride)

5/9/2019: 103.1 cc measured by 3T mpMRI of the prostate (after about 9 months on dutasteride)

Prostate volume measured by MRI is supposed to be the most accurate followed by TRUS and then TAUS. I viewed the MRI images prior to receiving the report and they were pretty clear. Using the measuring tools provided in the DICOM viewer, I measured around 85 to 90 cc using the ellipsoid formula. However, the radiologist emailed me after I mentioned these volume results in an email that UCSF uses a 3D model to get the volume of the prostate. This model is more accurate than the simple ellipsoid formula used in TAUS and TRUS.

Regarding TRUS, I have a copy of the TRUS images and I wonder how the urologist was able to mark some endpoints in several black areas on the photograph. I'm sure it is an educated guess, but I now suspect that the TRUS underestimated my prostate volume significantly.

For me, the 3T MRI clearly provided the best estimate of prostate volume. However, I was hoping for a size around 70 cc (or grams) based on the TRUS of 100 cc before dutasteride and a typical 20 to 30% reduction in prostate size after 6 to 12 months on dutasteride. I was really hoping for a smaller size because I want to have all BPH procedure options open to me (some are not recommended for large prostates of 100 cc or more). Others like PAE work better on larger prostates.

I'm now considering what I will do next.

If you made it this far, thanks for reading my long post. I wanted to provide a complete accounting for those that are inquisitive and/or anxious. BTW: The total final cost for this MRI was $1,305, which I paid for out of pocket.

rdemyan,

Who did you get to read your 3T MRI ? I live in Fremont California and am looking into 3T MRI at Stanford Medical Center or a private place in Fremont next to Washington Hospital. My PSA has measured around 6.3, several times in the past year. The free PSA measures 17.3, and I am 70 years old, so according to the data, I would have a 23% risk of cancer. However the data is based on people who do not use catheters. I have been doing CIC for more than a year now so I think that is the cause of the high PSA, but my Urologist wants to do a biopsy. I would rather do a 3T MRI even if I have to pay for it. I have heard from others on this site that it is important to find someone who is experienced at looking for cancer lesions in the images. I suppose I could upload them to Dr K in Houston, he would be one of the best persons to read them.

Do you think Medicare and Medigap would pay for the MRI if the doctor said they were looking for cancer lesions ? Dr K in Houston may know how to explain the need for the MRI to Medicare to get it covered, which would pay for a flight to Houston and hotel, and if there is need for a biopsy he could do it at the same time as Howard suggested.

Thomas