MRI alternative to traditional biopsy?

Robert, a multi-parametric MRI would be a good thing to have especially if you are considering continuing with active surveillance. That will do a good job of finding any cancers beyond your current G6 and/or giving some target areas for the biopsy. Which reminds me, AS is far more than WW and I would advise using a physician that is experienced in guiding AS patients.

Finally, a number of us on this site (including me) had our biopsies done with IV sedation. A nice little nap and no pain. You might consider that.

Jim

A 3T mpMRI used by a great radiologist can tell you a lot. I recently spoke to a radiologist who claims it can replace a biopsy completely, but I'm not convinced. He also believes that the endorectal coil adds little with a 3T machine. It's very good at picking up larger (5mm+) and higher grade (GS≥7) tumors, but not so good at smaller and lower grade ones. Some would argue that that's all one really needs for Active Surveillance. Most programs will want you to have at least a follow-up biopsy, which may be mpMRI-targeted. If that shows no progression, some programs will let you go a longer time monitoring with just the mpMRI. It all depends on the program, the capability of the radiologist, and the individual's progression, if any.

- Allen

I had a 3T MRI w/coil and though uncomfortable, it showed a significant lesion that DRE or a TRUS biopsy would never have discovered.

I'm a believer and it gives me significantly more information to make my treatment decision.

Allen is spot on. It did not show any of the GS 6 that the biopsy revealed and the lesion turned out to be GS 7.

The MRI may not replace the biopsy soon for most, but I I cannot see why you'd do one without the other.

I had a 3T mpMRI this year in May. It was helpful, but I agree with Allen right down the line, he describes it well. It is another tool, provides another data point, but I don't believe it is definitive. They didn't do the coil thing with me, 3T machines apparently don't need the coil.

My story -- I had a biopsy in Jan, and it indicated G6 in 2 cores, and G7 (3+4) in 3 cores -- total status was 5 positive cores of 12, with volume between 5% and 40%. mpMRI in May didn't see anything. I agree that mpMRI does less well with generalized (vs localized) tumor, and will identify G8+ much more significantly than G6 and G7.

I had RALP a month ago, pathology confirmed G7 (3+4), that was not in a defined tumor but rather was spread on both sides still contained w/in gland. So, it seems that biopsy and MRI both performed reasonably and found what they should have.

If you have G6 from first biopsy, then I anticipate MRI would reasonably confirm that status. If you have progressed at all to G7+, then MRI can pick that up, especially if tumor is localized. If you could couple that with other confirming information like stable PSA, then this might be a valuable checkpoint.

But, as much as we all hate to say it, biopsy is where you'll really know your status.

I’ll bring up the 3-D Color Doppler Ultrasound as another possibility, but I think I’ve read that the 3 Tesla mpMRI is better. Can anyone confirm that?

Also, Philips has apparently developed a 3.0T Endo coil to be used in with their Achieva 3.0T MRI scanner.

-- Tigerfan

I had a steadily rising PSA and negative DRE for 12 years. Finally, in August 2013, my GP referred me to a Urologist wanted to wanted to do a TRUS biopsy. I told him no thank you and asked for an order for a 3T mpMRI. He declined, do I fired him.

My GP wrote an order and I had a 3T mpMRI at UCSF in January. UCSF is the industry leader in prostate imaging and they do use an ER coil - and abdominal blanket - for the best images possible. The resolution is much better than anything a color doppler can do and there are several other tests done at the same time (http://radiology.ucsf.edu/patient-care/services/prostate-exam-study). The ER coil is uncomfortable, but not terrible. Some say the EC causes distortion of the prostate but it really depends on the Radiologist interpreting the scan. If they're comfortable reading with the ER coil, they stick with it because the imaging is said to be superior. Results indicated I had a single 1.7 CM lesion with no extra capsular extension, no invasion of seminal vesicles, lymph or bone. A biopsy was in order.

My GP wrote a MR guided biopsy order, back to UCSF in May. Four core samples resulted in 2 GS6 and 2 GS7(3+4). Only considering RT or focal therapy so off to see Dr. Rossi at Scripps Proton Therapy Center in LaJolla, CA, Dr. Scholz (prostate Oncologist) in Marina Del Rey, CA and Dr Erick Walser at UTMB. Ultimately decided on FLA at UTMB.

In June, I flew to Galveston on Thursday, had my FLA procedure Friday and flew home Saturday. My first 6 month post-FLA exam is in December - a PSA & 3T MRI.

The 3 Tesla MRI is a game changer for prostate cancer.

http://radiology.ucsf.edu/patient-care/services/prostate-exam-study

RobertT said...
Well, would like to do a baseline MRI without anything inserted

I'm not at all sure what you mean by "baseline." Have you asked if your radiologist uses an endorectal coil? Not everyone does. The use of mpMRI with AS is to find lesions that are suspicious for significant and higher grade cancer. If you are not using it for that purpose, what is the purpose of doing it at all?

Unless your Uro felt something - Stage T2a or above - there is seldom any point in getting just a normal MRI.

- Allen

Robert,

My point was that an mpMRI is part of your AS diagnosis procedure - the other part being the biopsy if suspicious lesions are identified. It's not just a baseline test -- it is looking for suspicious lesions requiring further identification. There is no point to having an mpMRI if you are not prepared to have a biopsy. Safe AS requires a commitment to having follow-up biopsies.

- Allen

I can only speak about my recent biopsy that was done about a month ago, but it may help others decide.

My first hospital wanted to do it the old way. Local sedation and pass the probe up the back passage to take the samples (about 12) I got to reading on here and found that type of biopsy was only about 25% accurate and may not pick up the PC, causing the procedure to be repeated up to four more times! That was not for me.

The hospital I am with now done a prostate specific MRI finding no specific areas of the prostate to target. It also gave the indication that there was nothing showing outside the prostate capsule, but with a fast rising PSA the followed this up with a (Template Prostatic Biopsy) taking 40 samples that has 95% accuracy. This was done under general anaesthetic so I was fast asleep and knew nothing about it. This was done by passing an ultrasound probe up the rectum, then the samples taken in a targeted way from outside the body through the perineum. After effects of this were being a bit tender in that area for a couple of days. Blood in the urine for about two weeks, the first few days was like something out of Halloween, my urine looked like pure blood and it scared me so much I had to sit down and pee so I could not see it. I also had blood in my semen and that has only just cleared.

I was in hospital for half a day and they would not let me leave until I was able to pee. For me the whole experience was not unpleasant apart from the blood thing after.

Questions that I asked my uro.........

Q: Why cant you use the results from the MRI?

A: Because it is not totally reliable in picking up the cancer and even if it does not show anything outside the prostate it would not be conclusive.

Q; If there is cancer within the prostate only then can the biopsy release cancer cells into the blood stream to from as bone mets at a later date?

A: Many years ago when much larger needles were used I only knew of two cases of this. In recent years I know of none.

I hope this helps others who are starting out on there “road to discovery”

Bobalou said...
Normal breasts are being removed based on genotype also useful for prostate. If the goal is to prevent death why not treat prophylactically with less aggressive protons, seeds or laser since either way if that PSA is high you have Ca until proven otherwise. I will post a followup.

I am not completely sure what you are trying to say here Bobalou. For a woman, removing a “normal” breast would be more of a physiological problem. For a man, any “aggressive” action taken on his prostate would be a more physical problem, because of the very long term and unpleasant life changing side effects that can often follow. I am in no way disrespecting a woman’s anatomy with this comment, but I don’t feel one can place both in the same context.

By the way. Welcome to Healing Well. I hope that you find what you are looking for here. If not then don’t be afraid to ask.

You are very welcome Bobalou and please keep us posted on how things go.

After reading Tall Allen’s post I do agree that there is little point in having an MRI if you do not intend to have a biopsy carried out after. The main idea of the MRI is to find target areas in the prostate from where it is best to take samples. In my case they found no specific target areas, so went in with all guns blazing and carried out a saturated biopsy taking 40 samples!.....The rest is history.

All the best.