Prostate tumor growing is detected

Hi Fuzzbox

An MRI won't really tell you much more than you already know about the lesion - only a biopsy can do that now.

Then it kinda depends where you live and the capability of nearby hospitals but a 'multi-parametric 3 Tesla MRI' might be a good investment... not because it will tell you that you have a lesion (you already know that) but because it can be used to enable a 'UroNav Fusion Biopsy', where the MRI data (lesion) is overlaid in real time on the biopsy ultrasound - enabling the Urologist to very accurately sample the lesion (as opposed to the traditional 'blind' biopsy approach). The Fusion biopsy increases sampling accuracy and is essentially the new 'state of the art'... and as such is not available everywhere, you may need to sniff one out...

I might be wrong but I don't think the Doppler data will enable a Fusion biopsy.

Paul

ONLY a biopsy can confirm whether you have prostate cancer or not...You can spend thousands of dollars on scans and still not have have the answer you seek...The biopsy is a 15 minute deal and is FAR less unpleasant than a MRI ..The urologist, armed with the information you have gathered, will know right where to look.....

Who will be paying for this?? You are turning a $950 procedure into a $6000 + procedure. If insurance is involved, you can expect some push-back or outright refusal..A good Uro should be able to use the images you already have to guide his hand when he clicks the sample button...

You will learn....ALWAYS ask and get insurance approval BEFORE you agree to a treatment or therapy.. Most providers will do this automatically but always check and be sure....

As to one area of concern, I will note that the nurse at Duke told me they would only use their own 3T mp MRI for fusion biopsy and would not use an MRI from somewhere else.

If you don't mind being in an enclosed space with a bit of noise, the worst part of the MRI is having to remain still for so long. Close to an hour or so. They put muffs/plugs on to help with the noise.

I do understand that some people need to be sedated because they freak out in a tight space.

I have had several with absolutely no issues. MRI's are not a problem for me or something to endure, just take a bit of time.

In your case, I do think you want to get pre-approval from insurance.

To be clear, the Fusion or Targeted Biopsy will use the mpMRI to target the lesion. And will also take addition cores.

A "blind" or standard biopsy may miss the lesion depending on size and location.

If I were you I would be trying to arrange mpMRI Fusion targeted Biopsy, actually that is the track that I am on.

Is the 3T MRI-guided fusion biopsy done in one visit or do you have the MRI done first....they analyze it and then take the prostate samples on the 2nd visit using the date from the MRI?

Thanks!

At Hopkins at least... It's two visits.

Paul

Thanks gentlemen!!!

That makes sense. I also would rather they have time to thoroughly access the mri images. Although I thought it was one visit....from your information and now what I've read about it on the net it seems like it would be two visits. I suppose I will find out this week as I intend to seek out a suitable facility and a good doctor.

As I've written above: If anyone has any recommendations of where to go and who would be the best Dr. to perform the test I'm all ears...or eyes. This would be in NYC.

I have found several places that can do this......although I'm not sure if there are different types of mri guided biopsies and the 3T fusion one is more advanced than others....I will look into this!!

fuzzboxman said...
.although I'm not sure if there are different types of mri guided biopsies and the 3T fusion one is more advanced than others...

I will rely on other members here to correct me in the event I am wrong, I am new to this but have been paying careful attention.

MRI "guided" may or not may be done in more than one session.

MRI "guided" at least at Winship/Emory is done by a radiologist in two sessions, in the second session the radiologist does the biopsy which is guided by the radiologist while the patient remains actually on the bed/platform of the MRI machine.

Fusion Biopsy is done with an MRI read by a radiologist indicating areas to target. In a second session, the MRI image taken is "fused" with Ultrasound of the prostate to create targets for a urologist to target the biopsy. Artemus or Uronav are a couple of the predominate systems.

One thing about PCa treatments and diagnosis, is that there are seldom black/white, yes/no answers and there are a lot of variables.

I was scheduled for the initial MRI at Winship/Emory recently for MRI guided, would have been unable to book the biopsy ( done in an MRI machine ) till mid-January. Came down with a difficult case of H Pylori, causing me to think I might screw up the MRI if tossed my cookies while in the machine. I was really having some problems with my stomach.

After canceling, I realized Duke ( a bit further in the other direction)may well be able to get me in for a Fusion biopsy by that time. So, I made an appointment for initial consult with Duke which comes up in about ten days.

Part of my thinking (suggested to me by a poster here) is that I would rather have a Uro doing the biopsy than a radiologist. If I lived two hours south of Atlanta rather than two hours north, I would have rescheduled with Winship/Emory.

I suggest you do whichever one is readily available that you have confidence in, the timing/convenience works for you, and your insurer will approve.

Either one should work fine if you have a good man doing them. I also leaned toward Duke because I thought the analysis, diagnosis and guidance forward post biopsy stands a little higher on the hierarchy of reputation for PCa.

My biopsy was done by Dr. Richard Lam at Prostate Oncology Specialists in Marina del Rey. CA. He did a targeted 4 core biopsy using CD ultrasound as a guide, not the images from a previous scan, but live imaging to guide the biopsy. IMO, the experience of the doctor means more for a targeted biopsy than whether they are using MRI or CDUS as their guide. The CDUS guided biopsy is significantly less expensive than an MRI, so if you will be paying out of pocket, you might consider flying to LA for the biopsy. You might save money even with the flight cost figured in. Their office is very close to LAX, and they do have a lot of out of town patients (myself included).