Prostate MRI

There are real advantanges to have an MRI first, and more medical authorities are coming out in support of having that as a standard protocol.

However, the insurance companies, at this time, will not pay for the MRI for an initial biopsy. That does not stop you for paying for one out-of-pocket, but it can be expensive.

First, know that that kind of sudden sharp rise in PSA is characteristic of prostatitis rather than prostate cancer, especially in a 40 year old.

Two-thirds of first biopsies are negative (even higher among men his age), and even when they are positive, they seldom detect the kind of low grade,insignificant cancer that is most prevalent. Because of this, it seldom pays to have an expensive mpMRI before a first biopsy. However, if the first biopsy is negative but PSA continues to rise inexplicably, or if he decides to go on active surveillance based on low grade cancer, an mpMRI is a good next step.

You should also be aware that reading an mpMRI is difficult, and there is significant inter-observer variability in interpreting the scans.

Before any biopsy, it is prudent to rule out the much more common sources of rising PSA: prostatitis, BPH, urinary obstruction, sex, and bike riding. It is also a good idea to get a Prostate Health Index (PHI) done instead. It is a simple, cheap blood test that is less affected than by benign causes than PSA or % free PSA (it includes both).

Thanks everyone! His free psa was 9%....he has been on 3 rounds of antibiotics....each in between PSA testing. He has had 3 DRE's, all been fine, except the obvious enlarged prostate. He had a CT scan for something else 8 years ago (age 32) and it showed enlarged prostate. Antibiotics were given and there was never a follow up. Insert eye roll. We will be paying out of pocket for the MRI since insurance won't cover it....any information is helpful!

My husband had an MRI guided biopsy (prostate and lymph node) but his PSA was 74 and they were sure he had cancer. They did the biopsy the same day they did the bone scan and the CT scans. The nice thing about the MRI guided biopsy is that, in his case, they only took 6 cores instead of the usual 12+. Each core was 90% or more so they probably didn't miss much. After reading what other men went through, he is very grateful!

CrazyLady said...
We will be paying out of pocket for the MRI since insurance won't cover it....any information is helpful!

I elected 3T mp-MRI before biopsy. Check out Dr. Joseph Busch, Chattanooga Outpatient Center, in Tennessee.