New member diagnosed from MRI after negative biopsy. Strange?

Windsor11,
If you had a multiparametric MRI on a 3T machine with an endorectal coil, some radiologists can detect PC with stunning accuracy. For example, in the following study, the radiologists were able to detect and distinguish Gleason 3+3 and Gleason 3+4 from Gleason 4+3 with 100% accuracy (based on prostatectomy pathology) using MR Spect, and they only used a 1.5T machine. A lot depends on the expertise of the radiologist, and the size of the tumor.

MR spectroscopic imaging and diffusion-weighted imaging of prostate cancer with Gleason scores
(I have the full text version)

They can fuse the MRI image with a real-time 3D ultrasound to conduct a biopsy.

- Allen

Wouldn't that be great! The hard part may be in training the radiologists.

Multi-parametric MRI can show high grade cancers, but as in my case it didn't show anything, yet I had Gleason 7 (3+4) in both lobes from base down to apex that the biopsy and post surgery pathology report showed.My diagnosis isn't considered high grade but definitely that should be treated one way or another and not something I would consider for active surveillance.

It would be hazardous to depend solely on a MP-MRI for diagnosis.

Windsor:

Let us know what you find out. Hope you get good results

Mel

Windsor11,

The gold standard for diagnosing prostate cancer is still a biopsy. The MRI is just a tool to find suspicious areas just as the digital rectal exam. Feeling a abnormality on the prostate can be indicative of a tumor, but it can also be due to prostate stones (calculi).

And a biopsy isn't fool profile, it only samples small cores typically 6 cores on the left side and 6 cores on the right side. Additionally there are zones within the prostate that usually aren't sampled. So it is possible to have cancer with a clear biopsy.

I'm sorry to welcome you to the club, Windsor. You're "favorable intermediate risk" right? (GS3+4, PSA<20 and T2) That gives you time to figure out what treatment is right for you - and all options are on the table. I recommend you don't rush into a choice, but take the time to interview lots of doctors (I interviewed 6).

One of the nice things about your mpMRI/US fusion biopsy is you have a much better handle on what's really there -- Much lower likelihood of an upgrade on post-RP pathology (if you choose that route). It also enables you to watch it if you choose to. It may surprise some here that Dr. Scholz is accepting men with favorable intermediate risk on Active Surveillance because he has confidence in his ability to track any PC growth with his fancy new CDUS machine. The same thing is true for mpMRI - I've been reading reports lately of detection of lesions as small as 2 mm - and the Gleason score as well. And you seem to have a top notch radiologist. I don't know if it's for you, but I mention it because I am delighted that new treatment options become available all the time.

- Allen

Windsor11,

Sorry he found cancer. At least you got it early.

Could you explain the guided biopsy procedure you had? I seem to remember Jennifer telling me that one had to go in and out of the mri several times during the biopsy. I didn't understand that.

I had also asked if I could have the biopsy without the conscious sedation and they had agreed to that. Since you were sedated maybe you can't judge, but how would it have been with just numbing the prostate and no sedation.

Sounds like Dr Yu is busy this week-end. He is supposed to get back to me with a doctor recommendation sometime this weekend. No cancer, but I still have prostate problems to address.

ETA: Just went back and read your op. The initial diagnosis based on the mri matches the diagnosis from the biopsy. Now we know this is not always the case, but it does show that a skilled radiologist can do a fairly accurate diagnosis from a mri.

Post Edited (richh) : 1/17/2014 6:47:45 PM (GMT-7)

Windsor11 said...
Tall Allen --

Yes, correct, I am a "favorable intermediate risk." My understanding is those of us in this category are blessed in that we have many options, but we are also cursed because we have so many options.

You have proton beam available in Hampton.

Richh --

You will really like Dr. Yu. He is a first-class, experienced prostate radiologist who is very accessible and intensely interested in each patient. He gave me his cell number and email address.

You go in and out of the cylinder because the 3D images are taken while you are totally in the machine. The biopsies are taken with the endorectal coil while only your, er, rectum and legs are out of the machine and therefore more accessible to Dr. Yu. But he still has the camera rolling to assist him.

My procedure took much longer than most because of the unusual position of my cancer. Accordingly, Dr. Yu had to "weave" his way into the malignancy with extra care and caution. Leave it to me to have a unique location for prostate cancer.

And please, please, please do NOT even THINK about having this procedure sans sedation. I am not a man who is overly sensitive to pain, but during this process I had to ask for a tad more sedation. The coil ain't my idea of fun. Truth be known, it hurts.

My next-door neighbor is as rich as Roosevelt and chose to have the proton beam in Hampton after he hired several medical experts to research all of his options. Seriously.

Godspeed next Thursday, my friend. Jennifer is even more charming in person than on the phone.

Windsor11

Mine was 45 minutes but the average is 20-30. They tell you one hour simply to prepare you.

I had three samples taken.

You are in the machine to get the color 3D images. The radiologist has to slide you in and out because 1) the needle biopsy cannot be performed in the machine, and 2) you come in and out so he can check and recheck the accuracy of the locations in the cancer for biopsies.

Remember that I was both apprehensive and groggy, so that is to the best of my recollection. Other may want to chime in.

My questions: What does the TN -- is that term correct -- register? What questions should I ask when I meet with the radiologist tomorrow afternoon? What other terminology/barometers from my biopsy should I ask about?

Thanks, everyone --

Windsor

Wow! Totally new perspective. But I am certain the urologists here in Richmond, VA, will recommend a radical prostatectomy.

Most prostate cancer victims in my range with whom I talked, however, went either with the seeds or radiation. One went with the proton therapy in Hampton, VA.

60 years old
PSA: 5.3
Gleason: 7 (3 + 4) in three cores in
T2
Stage 2 (radiologist and pathologist assumption at this point; yet to meet with oncologists/urologists)

Not ruling out any options, but I do have the luxury of not rushing into anything right away. Leaning toward seeds or radiation.

Tall Allen, rich, lapilot, compiler, what you do think?

gunfighter, richh, tall allen et al. --

Rich, how did your MRI biopsy at Massey go? Gunfighter, Tall Allen and all -- thanks for your concern and assistance.

Here aren the rough parameters of my final pathology report with some personal info:

60 years old
Health otherwise: Excellent
April 2013 PSA: 5.7
Traditional biopsy in May 2013: Results benign
Urologists suspected prostatitis and subscribed 30-day regimen of Cipro
October 2013: PSA 5.3; active surveillance begins
December 2013: PSA still 5.3; patient inists on MRi;
January 2013: 3D MRI at Massey Cancer Center in Richmond, VA, shows suspicious area in transitional zone
Mid-January 2013: Final pathology report concludes there is only one tumor, moderate in size, located in the transitional zone at the right apex; Gleason Score: 7 (3+4)

I recognize the treatment options are legion, but I wanted to seek guidance/recommendations from the more experienced members of this forum.

Thanks --

Windsor11