Tests for spread

In my opinion all existing image tests have limitations in identifying localized prostate cancer or its spread. CT and MRI detect deformations (tumor volumes) taking pictures in sectional series pitched at 0.9cm and 0.4cm (CT and MRI respectively), therefore limited in identifying smaller deformations (tumors). Any tumor located between these sectional pictures would not be identified providing a false negative. CT is worse than MRI. 

The nuclear imaging with BS or PET identifies malignancy at cellular level (microscopic) but depend on the radiopharmaceuticals (tracers) capabilities in being absorbed (metabolic) by the cells targeted in the exam (bone or prostatic respectively). Apart from above capabilities, the tracer should be fully active by the timing when the picture is taken, before being excreted. This timing is crucial as too early or too late could lead to false negatives. 

The choice in radiopharmaceuticals varies but the most common aim in attaching to the most active tissues therefore using loads of glucose (energy). For instance the FDG. The typical BS uses the radioisotope Tc99m that aims/accumulates at bone lesions with  chemical changes.

In PET scans for PCa the tracer aims the particulars of the cells where the PSMA (prostate specific membrane antigen) is thought to be the most practical. However, this antigen is also active in some other type of cells (eg; saliva, etc) requiring professional reasoning to distinguish which tissues may relate to PCa.

PET scans are specific but require the 3-D capabilities of CT or MRI to provide accurate location of what has been detected by the PET machine.  Surely a PET/MRI combination will be more accurate than the PET/CT, but in treatment the difference wouldn't matter much. 

Accordingly, micrometastases spread is difficult for being detected in CT or MRI but PET scans also depend on the type of the tracer, on the timing of the picture section, on the level of activity of cells and judgement/experience of the radiologist. These apply independently of the Gleason grade of the cancerous cells. Multiparametric analyzes are the best in defining imaging study results and only a biopsy certifies cancer.

Best 

VGama 

Currently MRIs use a 1.5 or a 3.0 magnet. The 3.0 provides better definition. The MRI may show extra capsular extension. I wonder which MRI you had. 

Studies have shown that Gleason 6 will not leave the prostate. The concern is that when there is a lot of Gleason 6, a Gleason 4 may exist. The Gleason 4 can leave the prostate. 

I agree with Georges comment, the chance of extra capsular extension is low, and I doubt that a doctor would authorize   an advanced image test. 

Rob,

The guy's above have all given good insight.  A few, like Vasco, gave a wonderful technical overview.   I think everything said distills down to two main observations:

1.  Scanning, even the best scans, are of limited value in detecting PCa, and miss it as often as they detect it.  The exception to this is if it is widespread and significant, and in that case, it is too widespread to hope for a cure anyway, and you are looking at a future of hormonal therapies;

2.  It is correct that most insurance coverages will not pay for a PET scan, based on your current numbers.  I doubt Medicare would either.  Most urologists would not recommed scans anyway.

max

Hi Rob,

Try a PET scan and see if that picks it up, see Vasco's comments above.  3+3 is not agressive but it still is cancer so in my humble opinion you need to know where it is inside your Prostate.  There are cases reported on this forum where 3 grade has later turned into a 4 grade. Repeated biopsies should let you know when it turns into a 4 If it ever does that. If nothing shows up on the PET scan then the only thing you can do is monitor via biopsy.  Just trying to help you step through this process so you have all the info at hand to help you make decisions on your Prostate cancer.

Dave 3+4

Rob.Ski said:

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Ok, then Clevelandguys comment makes no sense to me.  How would I know where the cancer is within the prostate without taking it out? 

Rob,

First of all, not everything in medical science makes sense; much of it does not.  Related to this, there are many desirable-to-know clinical things that doctors do not know.  I currently have an extremely rare autoimmune condition that was detected in the monitoring of my former lymphoma.   The condition is almost totally not understood, no cause is known, and there are no treatments.   

A matrix biopsy is the best and most accurate indicator of where the tumors are.   Other biopsy results, such as whether there is perineural involvement or positive margins, are also of high value.   But you nailed it:  the ULTIMATE way to know what is where in the gland is a pathology analysis in a removed gland; nothing else comes close.   I do not 'recommend' RP, or anything else, just sharing factual observations.    If you are highly anxious over this question, then given your very minor specifics, either RP or RT would likely cure your disease, the same as it would likely cure any other man with your specific results

A T3 mri can show suspicious lesions within the prostate and rank them by the likelihood of being a significant cancer, 3+4 or above. The scale that measures this is called pirad. The scale goes from 1to 5, 5 being most likely. Pirad was not included in your report. The mri can show if it in one lobe or two, and where within the prostate.

A gallium contrast can be used for more accuracy. it does not look like a contrast was administered.

Additionally there was a problem in doing your mri since you were not completely prepared. 

Also several images were missing from your mri  

Basically in my layman's opinion your mri left a lot to be desired

Hi,

SBRT is a good way to go, people have had lots of success with treatments like Cyberknife..

Dave 3+4

New PSA test shows 52.46 as new result. So afraid cancer has spread. Anyone with this high number after radiation & seed implant? Had prostate cancer diagnosis in 2011 & last test results until now was in 2019 with a score of 19. Help would be appreciate.