How Accurate is the 3T MRI at detecting cancer

tonycue
tonycue Member Posts: 39

Hi Guys, I'm new here, Live in the UK (hope this is OK here this being a US site). Currently awaiting a biopsy and just wondering if anybody here has had this experience or knows the answer to this question re: 3T MRI scanners..... 
Briefly: 58 Years old, Live in UK so under NHS, been referred by GP and having tests at hospital for a sudden rise in PSA from regular 3.1 to 7.5 after a 14 month gap between tests.....Whilst waiting for hospital to get in touch went to a private clinic for a new PSA test with "Free PSA".....This test came back at 4.3 PSA and a free PSA of 23%.(2 weeks later)....Also had a consultation with private consultant from this clinic who specialise in prostate health and problems. This guy is a well known Professor of urology with an international reputation, many books and papers published etc....40 minute consultation and DRE and he tells me "No Cancer"....."Great" I thought and skipped off.....I was happy to call it a day and cancel the upcoming hospital appointments My wife although pleased had other ideas and insisted I stick with the program. 
 So since then I have been called to hospital, had a cystoscopy (Tests clear)...a CT Urogram and a 3T MRI....They wanted to give me a biopsy, but in light of the lowered test result and the "diagnosis" from the Prof I asked my hospital consultant (via his secretary as I have yet to meet him) if I could swerve the biopsy and see what the MRI threw up...He agreed. ....Hospital appointment yesterday to discuss results with urology dept. Doctor called me in, never introduced himself, was a bit stand offish, not unpleasant but very business like, asks why I did not have the biopsy? (he isn't the consultant obviously) I explain my reason and he asks to see the lowered test results, I show him. He explains that the MRI is showing "something" and it is small. I ask him if it is confined to the gland (it is) ....But they need to do a biopsy to see what it is. I say that I thought that a 3T MRI could tell the difference between something nasty, something benign or inflammation....He says that this is not the case, his words were something like: "PSA means nothing, Free PSA means nothing, Scan means nothing only a biopsy can see what this is" 
He did say that if I wasn't worried I could leave it until the next PSA reading to see what has happened, but I don't have that kind of personality. 
I now feel like I have shot myself in the foot as I have now booked a biopsy for 2 weeks time and the results 2 weeks after that, so instead of finding out yesterday I now have another 4 weeks to sweat before I get a (maybe) definitive answer.......Basically my question is this: Has anybody had the experience where an MRI scan has shown up something which turned out to be nothing to worry about....or is the doc just not being 100% straight with me? 
    Thank you in advance 
         Tony 

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Comments

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    edited August 2016 #2
    Only the biopsy can diagnose the cancer

    Tony,

    Welcome to the board, however, keep in mind that you have not been diagnosed with prostate cancer yet.

    From what you write, I have to agree with the assertions of your unpleasant hospital attending doctor (typical of busy urologists). At present times, only the biopsy can diagnose the cancer. All other tests and exams (image studies) are complimentary to the biopsy results and will be essential when judging/determining the status of a patient. These can predict the clinical stage (advancement) of a positive case. In other words, all the data collected is necessary and important. Keep a file with all copies.

    Regarding the MRI tesla 3 (3T), we know that it provides better image (higher resolution) clear to identify disturbances, but as your doctor commented it does not distinguish cancerous cells from benign. Some radiologists are highly experts in interpreting the image study leading guys into avoiding a biopsy but nothing can be 100% assumed correctly. Those dark spots in image could be cysts or calculi non cancerous. However, if a sample is taken from these tissues (guided biopsy) and found by a pathologist to be cancerous then the patient would be declared positive and the image exam would provide the extend (size) of the tumour.

    I understand you being worried, but the high PSA and the 23% free PSA is indicative of probable cancer. Surely, the PSA can be high due to other causes and a blinded biopsy can miss affected cancerous tissues but in the end, the biopsy may provide you peace of mind.

    Here are some links that may be interest to you;

    http://www.cancernetwork.com/articles/percent-free-psa-test-may-prevent-unnecessary-biopsies

    https://www.webmedcentral.com/article_view/3463

    Best wishes,

    VGama

     

  • tonycue
    tonycue Member Posts: 39

    Only the biopsy can diagnose the cancer

    Tony,

    Welcome to the board, however, keep in mind that you have not been diagnosed with prostate cancer yet.

    From what you write, I have to agree with the assertions of your unpleasant hospital attending doctor (typical of busy urologists). At present times, only the biopsy can diagnose the cancer. All other tests and exams (image studies) are complimentary to the biopsy results and will be essential when judging/determining the status of a patient. These can predict the clinical stage (advancement) of a positive case. In other words, all the data collected is necessary and important. Keep a file with all copies.

    Regarding the MRI tesla 3 (3T), we know that it provides better image (higher resolution) clear to identify disturbances, but as your doctor commented it does not distinguish cancerous cells from benign. Some radiologists are highly experts in interpreting the image study leading guys into avoiding a biopsy but nothing can be 100% assumed correctly. Those dark spots in image could be cysts or calculi non cancerous. However, if a sample is taken from these tissues (guided biopsy) and found by a pathologist to be cancerous then the patient would be declared positive and the image exam would provide the extend (size) of the tumour.

    I understand you being worried, but the high PSA and the 23% free PSA is indicative of probable cancer. Surely, the PSA can be high due to other causes and a blinded biopsy can miss affected cancerous tissues but in the end, the biopsy may provide you peace of mind.

    Here are some links that may be interest to you;

    http://www.cancernetwork.com/articles/percent-free-psa-test-may-prevent-unnecessary-biopsies

    https://www.webmedcentral.com/article_view/3463

    Best wishes,

    VGama

     

    Hi VGama, Thanks for replying

    Hi VGama, Thanks for replying.....I was under the impression that although not brilliant, a free PSA of 23% wasn't a terrible figure....In fact the British association of Urological surgeons use a figure of >22% as most likely benign....My lab test stated > 23% (so guess I'm on the cusp)....that and the fact that my first test of 7.5 dropped to 4.3 within 2 weeks ....(does this sound like a man clutching at straws?)

    I have already read the free PSA article (in the last 5 weeks there probably isn't a PCa web page that I haven't read)...a lot of people use a cut of of 25% but I have read a lot of scientific research where 23% is used.....(whoops there goes another straw Frown)   The other article I shall digest later thanks

    Since my consultation with the grumpy urologist I have learnt about the PI-RADS scoring system for MRI imaging....(wish I'd had this info before)....Just wanted to know really if the doc was not telling me the whole truth for whatever reason

    Thank you for your informative post and for taking the time to reply

       Tony 

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,721 Member
    edited August 2016 #4
    Welcome

    Welcome to our Board, Tony.

    We have contributors from all over the world. In no sense are we restricted to the US.  I myself herald from the US state of South Carolina, founded by English aristocrats in the 1600s.  I love the UK, and as a US submariner visited Portsmouth, England once, Dunoon, Scotland many times, and Faslane (Her Majestie's Naval Base and lead submarine facility)  once or twice.

    As Vasco noted, neither the free PSA or conventional PSA testing proves anything.  The UK may have protocols which suggest 'probabilities,' but I have not heard of such in America. But either way it remains a subordinate bit of data, to assist after a biopsy is in hand.

    Your conventional PSA rise, or 'vector' (also called 'Doubling Rate') was significant, but it also does not 'prove' anything.  In your particulars, I would go ahead and get a biopsy,   Prostate cancer ("PCa") is virtually always very indolent/slow moving, so the two week delay that you mentioned will be completely irrelevant, of no significance.

    max

  • tonycue
    tonycue Member Posts: 39
    edited August 2016 #5
    Thank You

    Hi Max, Thanks for your welcome, If I'm honest I'd have rather not received the invite Yell but Hey such is life.....

    Always nice to meet an Anglophile, and a Submariner at that....Many years ago I used to train with a group of Royal Marines based in Portsmouth (two of whom were old schoolfriends) They always managed to whip my butt no matter how fit I thought I was

    As far as my diagnosis is concerned....I'm all over the place with that.....When it jumped to 7.5 from a 3.1 14 months previously, I thought "Oh S**t"...then after the drop 2 weeks later, I thought that maybe I was out of the woods....My private guy in London (who ironically had his prostate removed 3 years ago by robotic surgery) told me "You are fine" ....I now am wondering whether he was just "playing the odds" although what he would have to gain from that I fail to grasp....I have spent the last 6 weeks in a bit of a daze, and have come to the conclusion that I am not the kind of guy you would want to be sharing a foxhole with (or a submarine come to that)....I have done nothing but trawl website after website, looking for clues, hoping that I'm going to find a loophole in the law.....Nothing thus far......plus, although my hospital doc has said that whatever is on the image is small and is confined to the gland, I have been having some hip pain in the last 3 months, and am now starting to worry even more.....My wife who is notoriously upbeat (or she's doing a damn fine acting job on my behalf) says that the hip pain is just my age.....I hope she is right, but I'm seeing all kinds of "Monsters" under the bed.

    Unfortunately I have an OCD personality and therefore all these awful scenarios keep playing on a continuous loop in my head, even though I know it's a waste of energy.....Can't teach an old dog new tricks I guess. Just got to suck it up and see what the next few weeks brings.

    I think that guys in the USA are much more health/prostate aware than we in the UK. I have read that nearly every man over 50 in the US knows his PSA "score"....probably a bit of an exaggeration...but certainy more than us Brits...The NHS don't have a dedicated screening service...they will offer you a PSA test if you're over 50, or if you're in a high risk group....but they don't advertise the fact (they only have a finite amount of money).....It's down to the couple of large cancer charities who are left to get the message across re: screening.....My GP wanted to refer me to the hospital 2 and a half years ago with my 3.1 (cut off for my age group is 3).....Like a typical man I put my fingers in my ears and sung at the top of my voice and pretended that all was well.....got tested every 6 months after that (always 3.1) got complacent waited 14 months and then got a big surprise 6 weeks ago, and here we are.....(If I have let this cat out of the bag I will have no choice but to kick my butt until it is black and blue)

        Anyhoo sorry for rambling on......Thanks for the welcome and best wishes

                             Tony

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    psa

    The results of the biopsy is the critical information. Although important the PSA can be looked at, only  as a trend, the individual points can be affected by a multitude of things: inflamation, sex before the PSA, exercise (especially bike riding) before the PSA, a digital rectal exam or massage before the PSA..even a hard stool.

    Even after the results of the biopsy, there are cancers (Gleason score measures aggressiveness) that are indolent, that is not likely to spread.....this is fairly common, and can very well happen in your case.....it may be  a good idea for you to do research about "Gleason Scores" at this point.

    At any rate you received good answers from the other posters. 

    Let us know of developments in your case...we will do our best to give input.

  • tonycue
    tonycue Member Posts: 39

    psa

    The results of the biopsy is the critical information. Although important the PSA can be looked at, only  as a trend, the individual points can be affected by a multitude of things: inflamation, sex before the PSA, exercise (especially bike riding) before the PSA, a digital rectal exam or massage before the PSA..even a hard stool.

    Even after the results of the biopsy, there are cancers (Gleason score measures aggressiveness) that are indolent, that is not likely to spread.....this is fairly common, and can very well happen in your case.....it may be  a good idea for you to do research about "Gleason Scores" at this point.

    At any rate you received good answers from the other posters. 

    Let us know of developments in your case...we will do our best to give input.

    expert opinion

    Hi, thanks for your reply.....I can assure you that in the last 6 weeks I have become a prostate cancer "expert" I could probably even take my own prostate out at a push.....So I'm well aware of the gleason scores and staging (although I'd rather not be)

    Biopsy week after next. Results 2 weeks later.....just got to wait.....nothing else to do....

     Regards   

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,721 Member
    tonycue said:

    Thank You

    Hi Max, Thanks for your welcome, If I'm honest I'd have rather not received the invite Yell but Hey such is life.....

    Always nice to meet an Anglophile, and a Submariner at that....Many years ago I used to train with a group of Royal Marines based in Portsmouth (two of whom were old schoolfriends) They always managed to whip my butt no matter how fit I thought I was

    As far as my diagnosis is concerned....I'm all over the place with that.....When it jumped to 7.5 from a 3.1 14 months previously, I thought "Oh S**t"...then after the drop 2 weeks later, I thought that maybe I was out of the woods....My private guy in London (who ironically had his prostate removed 3 years ago by robotic surgery) told me "You are fine" ....I now am wondering whether he was just "playing the odds" although what he would have to gain from that I fail to grasp....I have spent the last 6 weeks in a bit of a daze, and have come to the conclusion that I am not the kind of guy you would want to be sharing a foxhole with (or a submarine come to that)....I have done nothing but trawl website after website, looking for clues, hoping that I'm going to find a loophole in the law.....Nothing thus far......plus, although my hospital doc has said that whatever is on the image is small and is confined to the gland, I have been having some hip pain in the last 3 months, and am now starting to worry even more.....My wife who is notoriously upbeat (or she's doing a damn fine acting job on my behalf) says that the hip pain is just my age.....I hope she is right, but I'm seeing all kinds of "Monsters" under the bed.

    Unfortunately I have an OCD personality and therefore all these awful scenarios keep playing on a continuous loop in my head, even though I know it's a waste of energy.....Can't teach an old dog new tricks I guess. Just got to suck it up and see what the next few weeks brings.

    I think that guys in the USA are much more health/prostate aware than we in the UK. I have read that nearly every man over 50 in the US knows his PSA "score"....probably a bit of an exaggeration...but certainy more than us Brits...The NHS don't have a dedicated screening service...they will offer you a PSA test if you're over 50, or if you're in a high risk group....but they don't advertise the fact (they only have a finite amount of money).....It's down to the couple of large cancer charities who are left to get the message across re: screening.....My GP wanted to refer me to the hospital 2 and a half years ago with my 3.1 (cut off for my age group is 3).....Like a typical man I put my fingers in my ears and sung at the top of my voice and pretended that all was well.....got tested every 6 months after that (always 3.1) got complacent waited 14 months and then got a big surprise 6 weeks ago, and here we are.....(If I have let this cat out of the bag I will have no choice but to kick my butt until it is black and blue)

        Anyhoo sorry for rambling on......Thanks for the welcome and best wishes

                             Tony

     

    Zepplin

    I loved the English group Led Zeppelin's early hit Ramble On. All manner of rambling is welcome...

    OCD can really jerk a guy around. The trick is to just do the clinically advisable things and remain informed regarding what the results show.  The thing to do now is get a biopsy.

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    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

     

  • tonycue
    tonycue Member Posts: 39

    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

     

    Not High Spirits, Denial

    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
    hopeful and optimistic Member Posts: 2,333 Member
    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

     

  • tonycue
    tonycue Member Posts: 39

    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,

    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.Frown Perhaps I should change my moniker here to hopeless and pessimistic Laughing

    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     

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited August 2016 #13
    Active Surveillance

    ....is the smart way to go..............the possible side effects of the various treatments, especially surgery can be  very severe..

     

    ed.......

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member
    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/

  • tonycue
    tonycue Member Posts: 39
    edited August 2016 #15

    Active Surveillance

    ....is the smart way to go..............the possible side effects of the various treatments, especially surgery can be  very severe..

     

    ed.......

    active Surveillance

    Hi H&O, I'm of course hoping that I don't have to make that decision....but my pessimism is getting the better of me. The Doc at the hospital said that if I "wasn't bothered" I could wait for my next PSA check and see what was going on. Well Doc I wasn't worried until you told me that your £2m machine has spotted something "suspicious". Now I'm very worried. I suppose I should take solace from the fact that he was willing to give me the option, but then again it's not his life. I don't have the personality to be told there's "something" there and not have to know what it is......That' s the trouble with PCa there are no hard and fast rules, even the best doctors can't predict outcomes it would seem. I'm now 58, still feel fit (apart from the twinge from the hip mentioned earlier). If a doctor could state unequivocally that I could keep an eye on this "thing" for the next x number of years, without the danger of it suddenly "ambushing" me between tests and getting up to mischief then I might contemplate it, but I don't imagine any Doc is going to guarantee that.....Therein lies my personal problem, maybe in time I could be persuaded, but for now I know I couldn't go down that road.....I'm very pleased that it is working for you.....Thanks for replying. Regards, Tony

  • tonycue
    tonycue Member Posts: 39

    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/

    mpMRI vs MRSI scans

    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
    hopeful and optimistic Member Posts: 2,333 Member
    tonycue said:

    active Surveillance

    Hi H&O, I'm of course hoping that I don't have to make that decision....but my pessimism is getting the better of me. The Doc at the hospital said that if I "wasn't bothered" I could wait for my next PSA check and see what was going on. Well Doc I wasn't worried until you told me that your £2m machine has spotted something "suspicious". Now I'm very worried. I suppose I should take solace from the fact that he was willing to give me the option, but then again it's not his life. I don't have the personality to be told there's "something" there and not have to know what it is......That' s the trouble with PCa there are no hard and fast rules, even the best doctors can't predict outcomes it would seem. I'm now 58, still feel fit (apart from the twinge from the hip mentioned earlier). If a doctor could state unequivocally that I could keep an eye on this "thing" for the next x number of years, without the danger of it suddenly "ambushing" me between tests and getting up to mischief then I might contemplate it, but I don't imagine any Doc is going to guarantee that.....Therein lies my personal problem, maybe in time I could be persuaded, but for now I know I couldn't go down that road.....I'm very pleased that it is working for you.....Thanks for replying. Regards, Tony

    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. "

  • tonycue
    tonycue Member Posts: 39

    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. "

    Where's the 25 year warranty??

    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  Surprised

        Regards   Tony

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    tonycue said:

    Where's the 25 year warranty??

    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  Surprised

        Regards   Tony

    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

  • tonycue
    tonycue Member Posts: 39

    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

    Active Surveillance

    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

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    mpMRI, a fabulous predictive tool for PCa

    Tony,

    Regarding the efficacy of image studies in detecting prostate cancer (your main subject of this thread) my take is that they have high points of acceptance but not yet 100% correct. A biopsy is still the way to go when in doubt.
    As far as I know, mpMRI is a valuable tool for those cases where a biopsy cannot be performed or it becomes unnecessary due to the evident advanced status of a patient (moving him straight to a treatment), or when a repeated biopsy is done under guidance (in a CT/MRI). The information gathered at the many clinics (in particular those involved with brachytherapy and guided biopsy) makes the PI-RADS score somehow acceptable but it is not a common substitute of a biopsy yet.

    In fact, since 2000 that there have been increasing efforts to use the image studies to diagnose cancer; however, each expert involved in PCa used his own experience (acquired along the years of practice) to report findings but no effort was ever done to standardize the interpretation in a system that could be used by the whole medical community. The PI-RADS (Prostate imaging reporting and data system) comes from these tentative efforts. The European uro-radiology  “built” a score system based on the data collected from several respected physicians who use to predict cancer not diagnose it.

    In 2010 I read a Chinese clinical study done by researchers in China that managed some evidence comparing image studies with post biopsy findings. The cohort was numerous but the image studies were from earlier CT and MRI machines, which image results would be out of date if used in building a “score” with more sophisticated equipment.

    In the PCRI annual conference of 2013, Dr. Jelle Barentsz, a respected radiologist specialized in interpreting image studies of the prostate from the times of the “Combidex” exam, (radiology at Utrecht, Nederland) introduced his video-conference system for analyzing image studies live, which were sent to him from hospitals around the world. Everybody recognized then the gap among radiologist at interpreting an image study. He wanted to have it standardized or teach the many on a principle in a reading process. At the same annual conference of 2015, Dr. Dan Margolis (a radiologist at UC Los Angeles) introduced the PI-RADS score which ranged from 1 to 5 namely highly unlikely to highly likely. These wordings are of prediction and that’s how we should consider it, or....... Can we trust that radiologists are now more coherent in analyzing an image study and do score it properly?

    I read with interest your cross discussion with Hopeful above. He is highly knowledgeable on the intrigues of AS. I also think that AS is the best initial option to consider in a PCa positive case, Surely AS is not for everyone but for those cases suitable for AS (low indolent risk), it provides quality living during many years till proper intervention becomes necessary, if any. Active Surveillance does not prejudice the benefit of a future treatment. One needs to learn how to sleep with the enemy in the same bed and still feel comfortable.

    Your scheduled biopsy will unveil the mystery, and it will tell you if you are rightful for an AS program.

    I hope they find the spots to be benign and that the seesaw PSA was related to a case of hyperplasia.

    Best wishes,

    VGama