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Endo Rectal MRI

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Posted 7/9/2015 5:38 PM (GMT 0)
I had my first PSA at age 50, I am now 68. At 50 my PSA was 3.5. I had annual health checks including digital and Psa over the years. In 2005 when my PSA reached 5.8 at age 58 my urologist recommended a biopsy, which turned out negative. As my PSA continued to rise I had a second negative biopsy in 2008 and a third in 2009. PSA hung around 9 for several more years then jumped to 15 in 2014. Doctor wanted to do a saturation biopsy (30 chunks). In discussions with my wife we decided to go to MD Anderson for any required treatment and further biopsy.
At first appointment with Dr. Davis at MDA he asked if I had every had an endorectal MRI. I told him no. He said he wanted to do that now. The MRI clearly revealed the suspicious areas and served to guide the doctor in the subsequent biopsy.
The biopsy revealed cancer. I am stage 3b. I had robotic surgery on January 12, 2015 and am currently undergoing adjuvant radiation therapy. My pathology revealed that i had every tick for stage 3b except the lymph nodes (48 which were all clear). Point is, if you have had more than one negative biopsies, ask your doctor about an endorectal MRI. If I had known of this MRI they may have found my cancer years ago before it had spread to my seminal vesicles, positive margin, bladder neck etc. I am doing pretty well now with Zero PSA 5 months after surgery but my Gnome evaluation was very high risk of metastasis as was my pathology. My doc here at MDA said having adjacent radiation was a No-Brainer. I finished treatment number 19 of 33 today.
Posted 7/9/2015 9:19 PM (GMT 0)
Glad you found it!

I had a 3T multiparametric MRI (mpMRI) which was used for guidance during my prostate biopsy. Instead of rectal coil, I used a phased-array pelvic coil that was strapped to my abdomen. The procedure found one suspicious location which was targeted, and the suspicious spot was negative, but other areas that wasn't indicative on the mpMRI were positive. Bottom line, mpMRI isn't very sensitive to low yield cancer but are great showing higher yield tumors.
Posted 7/9/2015 10:05 PM (GMT 0)
Pauull, welcome to Healingwell. Sorry for your G9 with not so great genomics. But glad that you went to MDA and they figured it out before sticking more needles in your walnut.

Stick around here, you'll get a lot of education and support from the group. There are some really knowledgeable members that will chime in.
Good luck on your journey, you aren't doing it alone here.
Posted 7/9/2015 10:14 PM (GMT 0)

Pratoman said...
Sorry for your G9 with not so great genomics.

I'm not seeing a G9, I read it as "PSA hung around 9".

It would be useful to know the Gleason from the biopsy.
Posted 7/9/2015 10:19 PM (GMT 0)
Max, my bad you are right. Apologies Pauuul. I guess i assumed a 9 because of the Genomics. Or maybe i mixed up the PSA with G. But you get the idea. Wish you didnt have to be here.
Posted 7/9/2015 10:27 PM (GMT 0)
Prato, no problem, I'm just touchy now being a G9 myself. :-)
Posted 7/9/2015 10:29 PM (GMT 0)
I get it, apologies
Posted 7/9/2015 10:56 PM (GMT 0)
My Gleason post surgery was 8 (4-4)
Posted 7/9/2015 11:56 PM (GMT 0)
Hey Paul - how about that, my Doc is also John Davis at MD Anderson. He ordered an endo-rectal MRI prior to my surgery and said it was a great help while he was rooting around in my pelvic area - my operation wound up taking 3.5 hours which Dr. Davis didn't anticipate beforehand. I'm also a candidate for aRT, I have an appointment end of the month at MDA with a radiation oncologist.
Posted 7/10/2015 2:35 AM (GMT 0)
My radiologist is Sean McGuire. I have a lot of confidence in him. Before my radiation began I had a bone scan, CT and another endorectal MRI. The combination of the three provided a broad base of information to evaluate the situation post surgery. Bottom line is everything looked normal. Dr. McGuire wanted to wait 5 months after surgery before beginning radiation to give everything down there a chance to heal.
Posted 7/10/2015 1:19 PM (GMT 0)
I thought this report on my endorectal MRA might be interesting. The detail for me, was astounding. I think readers will be able to appreciate the assistance this "invasive" MRI provides in locating the suspicious area during a subsequent biopsy. I think it is a great tool for those in need of one.

Technique: Prostate MRI with endorectal coil acquired at 1.5T with and without contrast.

Findings:

The prostate measures 5.3 x 2.6 x 4.5 cm.

Changes of benign prostatic hypertrophy are seen in the central gland.

Dominant lesion is located in the anterior central gland extending from base to mid, 10-1 o'clock, best appreciated on series 8, images 15 through 19. The lesion demonstrates T2 hypointensity reduced ADC. Suspected involvement of the bladder neck (series 4 image 12). In view of large burden of disease, extracapsular extension along the anterior surface of the gland is suspected.

Additional lesion of the right peripheral zone, midgland at the 7-8 o'clock position (series 8, 12 image 21), without evidence of extracapsular extension.

Concordant enhancement.

The neurovascular bundles are within normal limits.

The seminal vesicles are within normal limits.

No suspicious regional lymphadenopathy is seen.

No suspicious osseous lesions.

IMPRESSION:
1. Highly suspicious for tumor throughout the right anterior gland, base to mid (10-1 o'clock). Concern for involvement of the bladder neck and extracapsular extension.

2. Additional smaller lesion of the right peripheral zone, mid, also suspicious for tumor (7-8 o'clock).

I personally reviewed these image(s) along with the resident's/fellow's interpretations, certify that if a procedure was performed I was physically present, and agree with the final report.
Posted 7/10/2015 7:54 PM (GMT 0)
Two endo-rectal MRIs? I don't know if all endo-rectal MRIs are the same, but mine was a very uncomfortable time so I'm not sure I could imagine a second one. That said, I know it can be an important diagnostic tool, so glad it was helpful for you.

And a belated welcome to our world. All the best in your battle against PC!
Posted 7/10/2015 8:14 PM (GMT 0)
Hi,

I understand that the endo-rectal part of the mri is not necessary if a 3T magnet is used. In my case, my urologist is confident in the results of  3T mp-mri. I have undergone three of those and one using a 1.5T magnet.

Posted 7/11/2015 12:43 PM (GMT 0)
Michael T, I agree that the endorectal MRI is very uncomfortable. During the first one I did not have any medication. Prior to the second one I verbalized my discomfort with the first and I was given two 10 mg. ativan pills prior to the procedure (one an hour before and the other 15 minutes before). That helped greatly. From conversations with other patients being treated at MD Anderson, Radiologist typically ask for endorectal MRI.

turpT1a, I found the following in an internet search that you may find interesting. It was at appliedradiology.com, Prostate MRI: Update and Current Roles. The entire article is interesting but I have copied below a paragraph specific to the use of endorectal coil.

In addition to the use of 3T magnets, another advance in MRI with respect to prostate cancer is the use of an endorectal coil with a pelvic coil.This approach has the advantage of increasing SNR with fewer artifacts and better image resolution than MRI without the endorectal coil. On the other hand, it creates discomfort for the patient and deforms the gland. However, one recent study indicated that the combination provides higher accuracy; thus, the use of the endorectal and pelvic coils is suggested for most studies. It has been said that a prostate exam at 1.5T with an endorectal coil is equivalent to one at 3.0T without the coil without further improvement or gain from 3.0T. Thus, many groups continue to use the endorectal coil and at the same time maximize the advantages of the higher field strength. If the endorectal coil is used, the patient should have IV/IM administration of buscopolamyne or glucagon to decrease the intestinal peristaltic activity during the examination. - See more at: http://www.appliedradiology.com/articles/prostate-mri-update-and-current-roles#sthash.N3mClyyd.dpuf
Posted 7/12/2015 1:29 PM (GMT 0)
Has anyone had an MRI done with both an endorectal coil and a pelvic coil as the article I read mentioned? Might be overkill. A couple of articles I read said that the pelvic coil with 3T magnet gives as effective a picture as the endorectal coil. I guess the point is that a good MRI is a good tool in identifying where to direct the biopsy.
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