How Accurate is the 3T MRI at detecting cancer

VascodaGama said:

Fingers in the ears and sung, pretending that all is well

Tonny

I admire your high spirits through wards the problem. I recall my times when confronting a similar situation after receiving the PSA results. It was high and worrisome and my grumpy urologist’s explanation did not help me at all. I was concerned and wanted to do things rightful not missing anything. I did all sorts of tests all negative with the exception of the PSA. The biopsy followed and it was positive in all needles. Denial was my first stance. I could not believe in the results and had an extra two needles taken out at a separate institution to confirm my wishes,………... I was wrong. I had cancer and everyone was correct.
We see in this forum many reporting the same dilemma over and over again. The tendency is to think that cancer is of someone else. We are the good ones and have done nothing bad.

My experience with the biopsy was a simple painless affair. I would recommend it to everyman at the first sign indicating probabilities to cancer (including those multiparametric MRIs). I take it as a means of screening but there are responsibilities involved and one should be prepared in advance in regards to its results. For instance, one should secure an insurance that would cover treatments before been diagnosed positively (NHS is free but conditional to certain exams and therapies). It is a mental night mare and even if the cancer is found to be none aggressive, we must find the courage to live with it.

Several prefer to have the situation obscured and conduct their life as usual. They could follow the matter with periodical exams and tests (MRI, bone scan, PSA, etc) even knowing that the probabilities are high for having the cancer growing uncontrolled. Symptoms would rule an intervention which could occur after many years of quality living (avoiding the risks from treatments). This is what your private guy in London may have implied.
The hip pain/sensation may be a neurological affair. Your mind may be playing tricks on you (it did with me too). The MRI can check on it.

Whatever decision you may take, please do not rush. Do things coordinately and timely.

Best,

VG

 

Hi VG.....If by High spirits you're referring to my singing with my fingers in my ears....That wasn't high spirits it was denial....I first got a DRE and PSA in 2004 at age 46, because of needing the toilet when out more regularly than my peers.....I had a vague idea about the prostate then, but wasn't really aware of it's role.....The DRE and the blood test were a total surprise.....I never realised that there was a test for this stuff.....I called the surgery a few days later and they said that my test was OK.....(I was happy to put the phone down and walk away)....I've only found out recently that my PSA then was 1.2....Not high but probably more than the median for my age group.......The problems never really went away, but I just got used to them.....adjusted my behaviour accordingly etc.....Only presented myself to the GP in April 2014 at age 56 when the problem started getting me up at night.....PSA now 3.1.....Cut off for my age 3.0  GP wants to refer me to hospital..... In my ignorance I assume that 3.0 is a "safe" level so what harm can 3.1 do? (bit like cholesterol).....Not realising as I do now that people under 2 can have PCa.....Maybe the Doc should have been firmer, but I can't blame her.....I took the decision to pass....Just asked if I could be checked every 6 months....She agreed and that's how it was for a few readings (always 3.1) so got complacent and left it for 14 months and then got my unpleasant surprise....I went mainly because my hip started aching, plus a bit of back ache that comes and goes.....and that is now what is freaking me out.....I may be noticing them more than I would usually.....Hell I may even be exaggerating them, but I'm not imagining them....I wasn't avoiding the biopsy because of the needles.....needles don't bother me, although I'm not looking forward to the procedure...I really thought that after what my private guy said (and he was unequivocal here) he looked at my new lowered test results done at his clinic's lab, he asked me some basic questions, gave me a DRE and said "No Cancer"....I hasten to add that this is not some back street butcher.....This guy specialises in the Prostate, he's a professor of Urology, has done some 950 Robotic surgeries, has written many books and scientific papers on the subject, collaborating with American doctors and professors at Sloan Kettering, John Hopkins etc.

  I had done enough research at the time to "know" that a DRE won't show anything suspicious a lot of the time....So when I questioned him about his confidence he said "I have felt thousands of Prostates....You do NOT have cancer...Now go and take your wife to lunch"......I still fail to see what he had to gain by this statement unless he genuinely believed it. Of course I wanted to believe him, so skipped out of his office and bought the most expensive lunch I have ever bought, and happy to do it. As I mentioned in my earlier post I was all for cancelling the hospital appointments (that denial thing again), but my wife is the one with the common sense.....So here we are....The hospital doc says this thing is small and it's still contained within the capsule, but I know small doesn't necessarily mean not nasty and I guess that unless they do other tests they wont know about any spread....This is what I am freaking about at the moment....Think this is called the "bargaining phase"...I'm still cheerleading for the Prof, but I think that my mind is leading me down other paths......None of them Rosy....To say I'm not taking this well would be an understatement...I agree when you say that we can't believe that it is us that have been picked on.....I have always tried to make light of stuff like this (all the time aware that both my mother and father were taken with cancer at reasonably young ages  70 and 65) ...I've always maintained a healthy weight, kept fit....Could have probably eaten a few more vegetables, but other than that....I now walk down the street and see older or obese men and say why me....guess that's natural......Anyway enough whingeing.....Thanks for your post and your kind words

    regards   Tony 

hopeful and optimistic said:

Lunch

Tony,

Things will work out for you......recomend that you take your wife out for another lunch...make it  today.

I was diagnosed in March 09, I am enrolled in an Active Surveillance protocol....still have not had any Active treatment.......by the way, like you, I have just had another 3 T MRI and am awaiting a biopsy......(always apprehensive before any of these tests, but does not interfer with living and enjoying life)

Best

 

Hi Hopeful and optimistic, Too late for lunch here in the UK, it's dinner time....But know what you mean......I have now realised that when the going gets tough, I'm not only a glass half empty kind of guy, I'm the glass is half empty and there's a dog poop in the bottom of it kind of guy....On the emotional roller coaster at the moment and they wont let me get off. Perhaps I should change my moniker here to hopeless and pessimistic

I don't know if I could do the active surveillance thing....I don't think I have that kind of personality glad it's working for you

  Good luck with the biopsy, hope it all works out for you

      Best wishes     

Swingshiftworker said:

MRI/MRSI Scans

When my PSA rose 3x's in a row about 1 1/2  years after treatment and a recurrence was considered possible, I was given an MRI/MRSI (magnetic resonance spectroscopic imaging) scan that detects for the presence of choline which is a marker for cancer.  The scan determined that I was clear for cancer and the rise just turned out to be the typical radiological bounce and my PSA level has dropped consistently ever since.

The MRSI scan is the only one that I know of (other than the similiar but yet different PET-Choline scan) which can actually detect for the existence and location of a cancer.   The following is a study of the use of the MRSI scan in prostate cancer dectection conducted at UCSF Medical Center where I was treated:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578527/

Hi Swingshiftworker, That PSA  rise must have been a major worry? ....Glad it worked out for you.

I have heard of the MRSI scanners that use spectroscopy to detect chemicals found in cancer, but I must admit to being a bit confused, are you saying that the mpMRI cannoct detect cancer? Ever since asking this question on several forums a few days back I have now been educated a bit more, and directed to various web sites and I am now under the impression that the mpMRI with a good radiologist has a pretty good sensitivity in detecting tumors...using the PI-RADS score they could even have a pretty good guess at staging said growths.....My doc says that the "something" on my scan needs investigating and only a biopsy will tell....I was wondering if he was just being "Coy" and maybe not trying to worry me unduly at this stage....I'm of course hoping that they genuinely don't know and that this is going to turn out to be something less nasty....Any further info you have from your experience would be greatly appreciated

   Thanks for taking the time to reply 

     regards    Tony

hopeful and optimistic said:

Active Surveillance/my case

Tony, If you click my name to the left , you will see what tests I have done in my active surveillance program. Additionally I listed information that you may find useful

Here is a quote from my page, that is  based on research for the logic that supports Active Surveilance

"Active Surveilance for delayed treatment

is a very viable treatment decision for low risk prostate cancer, since 97 percent of men with LRPC are likely to die of something other than prostate cancer. The pathologic stage of patients who are closely monitored, is similar to initally treated patients with LRPC, so the treatment decisions will be very similar. I selected Active Surveilance as my treatment decision in March, 09 . I plan to continue with this treatment option for the rest of my life if I can. If not I feel that I will still be able to seek any necessary treatment. "

Hi H&O....Interesting statistics, obviously you had very low involvement, and got onto a research project, and they seem to be throwing all manner of tests your way.....I'm glad that it is all working out right for you....I'm 8 years younger than you were when you got your diagnosis (nice birthday present) not that that makes any difference.....66 is the new 40 right?......Maybe if the docs were to give me a 25 year guarantee along with the free servicing I might (only might) sign on the dotted line......I wonder that when you're going for one of your regular scans, psa tests etc. whether you now take them in your stride, or is there always a sense of trepidation while awaiting for the results?.......Although I realise that with surgery, radiotherapy and all the other treatments there are follow up tests that I guess cause a few sleepless nights for everybody.....Unless you're made of stone....(I realise that I am not....My family crest is two white feathers  ) 

    Regards   Tony

hopeful and optimistic said:

ony,

ony,

When I was first diagnosed I when through all of those intense negative feeling. This continued for several months. I was afraid that the cancer would spread outside the prostate.  At that time Active Surveillance was not very popular, while radical surgery and some forms of radiation was pursued by the vast majority. Since then there have been studies that have been done that reinforced that Active Surveillance is the best choice under the circumstances.

During this time that I have enjoyed a quality of life (7 1/2 years so far) I have had time to investigate various Active Treatment types. Additionally new drugs, technology and methods of localized treatment such as SBRT aka Cyberknife have been done and are fairly mainstream which are now available.

Many men when first diagnosed, are shocked and afraid, and simply want to get the cancer out of their body. This is a natural reaction, however it is a wrongful one, since the side effects from these radical treatments are very substantial. In fact for low level cancers the long time prgression of disease  are similar between those who have had surgery and those in an Active Sureillence program. Also now-a-days techology for AS are improved with better results. 

To emphasize in the usa, and  the regulations for administering PSA have changed a couple of years ago, so there are less diagnostic psa's for many, thus resulting in less men being diagnosed and less radical treatments (these guideline were most likely changed because of the overtreatment among those with low level disease.....by the way many do not believe that a gleason 6 is a cancer, and the term cancer should not be used to describe a gleason 6.  

There is a man who was less than 35 when diagnosed the prostate cancer who is in the same program as I am. He has been in this program for years, and recently fathered a child. He continues in this program. I am treated in a top tier center of excellence. There are also other centers of excellence that run Active Surveillance programs for men. This treatment type is not a fly  night treatment and is considered valid.

Tony, you do not know if or if not you have any cancer at this time, but if you are diagnosed with a low aggressive, low volume disease this can be a consideration. 

In my own case, my level of apprehension has declined in the last 7 years. When I am waiting for the results of my tests or have to make a decision now my level of apprehension is a one or two out of ten...........When I was diagnosed my level was 30 on a 10 point scale. This lasted for several months.

I hope that this helps

Hi H&O, You're absolutely right of course.....It's just that I have realised that I am not the right personality type to cope with any kind of disease.....I've never been a good patient, even with a head cold. When a doc tells you that "something" has shown up on an MRI scan a cold clammy hand grabs at your innards and won't let go...(I lost both my parents to cancer so am always aware that genetically I'm in the losers corner). You don't mention if you are married, but if you are I wonder if your relationship "changed" at all? My wife has been amazingly supportive..and positive....I have been finding myself acting very badly towards her....(I know it's the fear). I even found myself "blaming" her for not making me go to the hospital 3 years ago when the GP wanted to refer me....(how unfair and bitter is that?). I imagine everyone reacts differently, but I'm not proud of myself for acting so bitterly....I'm sure that everybody here has found that the waiting for results is the hardest part.....I only have myself to blame for that part of course "mea culpa"

   Thank you for taing the time to post....It does help to talk to someone who has experienced some of the same emotional turmoil.....

      Keep on keeping on     Regards    Tony