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Posted 2/12/2018 2:26 PM (GMT 0)
Hello again....nervous wife here.

My husband has an MRI scheduled for tomorrow morning....based on those results, they will either do a biopsy or not. I understand that only a biopsy can confirm PC...however, what exactly will they be able to tell from the MRI? Suspicious areas?

Also, for those of you that have had MRI's using the coil...how uncomfortable is it?

Thanks, as always!
Posted 2/12/2018 2:33 PM (GMT 0)
I had an MRI with endorectal coil (with contrast) and it was very uncomfortable but that might just be me. Whatever the contrast stuff they used on me made me feel awful for several hours. My surgeon ordered the MRI as a visualization tool for surgery and not for diagnosis, he said it was extremely helpful while he was cutting my prostate out.

Why are they doing an MRI before a biopsy?
Posted 2/12/2018 2:43 PM (GMT 0)
Since my husband is only 40, and his only symptom is a high PSA and an enlarged prostate, his urologists wanted to save him from having multiple biopsies, should the first one come back negative....so the MRI is to get a better view of his prostate, and from there the urologist will know exactly what areas to biopsy. That is my understanding anyways. I'm a bit confused by it, so hoping to shed some light on it...
Posted 2/12/2018 3:51 PM (GMT 0)
If he has a mpMRI they will probably classify suspicious areas according to the PIRADs system. PIRADs 1-2 are not significant. PIRADs 3 means suspicious of significant disease (SD). PIRADs 4 is highly suspicious of SD. PIRADs 5 is very suspicious of SD. In my case, it seems this gave a more accurate information than the biopsy. However, a positive biopsy is still needed to be treated.
Posted 2/12/2018 4:04 PM (GMT 0)

CrazyLady said...
Since my husband is only 40, and his only symptom is a high PSA and an enlarged prostate, his urologists wanted to save him from having multiple biopsies, should the first one come back negative.... from there the urologist will know exactly what areas to biopsy.


That is exactly what happened to me. The first biopsy missed the tumor entirely and came back negative. My urologist did not offer an MRI, rather I had to wait while my PSA went up and up.

Eventually I got the MRI which located the tumor and I was finally treated. I think the insurance companies mandate that it be done this way. It seems they feel it is better to pay for TWO biopsies, three surgeries and eight weeks of radiation plus two years on Lupron, rather than pay for an MRI when the cancer is still small and easier to treat.

Your husband is fortunate that his urologist is thinking ahead.
Posted 2/12/2018 4:53 PM (GMT 0)
I had mpMRI at Duke and they used the coil. It was very uncomfortable. I asked why they were using it since it was a T3 machine and really not necessary and the explanation was that it was being evaluated and most likely would be discontinued in a few months. Guess that didnt happen. I found the worse part of the procedure was not being allowed to move at all for 15-20 minutes at a time. Not even being able to clear my throat or slightly shift position was difficult for me. I think there were 6 or 7 different views and between each view was a little time to relax. I had to repeat one of the views because I moved slightly.

I had negative biopsy 1st time too. Looking back I'm sure my cancer was there just didnt find it with 12 core biopsy. As my PSA continued to rise even though my pca3 was very low and free psa was not bad, I insisted on 24 core saturation biopsy. One core contained cancer. I wish I had insisted on mpMRI before 1st biopsy.

Yes the radiologist will identify any areas he/she deems suspicious. Small Gleason 6 cancers are often not seen as suspicious, which is a good thing since they probably would do no harm and finding them on a biopsy causes the patient a lot of distress.
Posted 2/12/2018 4:58 PM (GMT 0)
Hi Crazy,

If I recall correctly, your husband is getting the MRI at Duke, correct? Duke uses MRI-guided biopsy technology which utilizes the MRI images to guide the biopsy if it's needed. If the MRI shows suspicious areas, specialized software is used to guide the urologist to take biopsy samples from targeted areas of the prostate as opposed to just taking random samples.

You may want to read this:
/www.dukehealth.org/blog/improving-prostate-cancer-detection
Posted 2/12/2018 6:37 PM (GMT 0)
There is a tendency for people to think of prostate MRI as a single well-defined concept. It is not.

First, there are differences in equipment. The "power" of MRI equipment is stated in TESLA units. 1.5T and 3T are typical. Higher is better, in that more detailed images can be obtained from more powerful equipment.

In addition, some practitioners have concluded that the use of 3T equipment can eliminate the need for the endorectal coil.

The term multi-parametric (MP-MRI) is used to denote that multiple types of images are produced which highlight different conditions.

Once the images are produced, they are analyzed by a radiologist. There is a wide range of experience/skill among radiologists. The radiologist must cross-correlate what is seen across the multiple image types to arrive at a conclusion. It is not a simple process. You want a highly experienced person to analyze the images.

The radiologist classifies what he sees into risk levels. Follow-on action depends on the level of risk observed.

If there are areas suspicious for cancer, biopsy is indicated.

There is a choice to be made as to who does the biopsy. It can be done by the radiologist in the MRI machine. This is the more expensive approach, since it involves time on the relatively scarce MRI machine. This approach allows the radiologist to observe the position of the biopsy needle relative to the suspicious area(s) without any distortion which may be introduced by the alternative methods.

The biopsy can also be done by a urologist using a technique know as fusion. The MRI images are imported to a separate machine, typically located in the medical office of the urologist. The urologist machine presents an image of the way things appear now. The MRI images, presenting the way things were in the past, are superimposed. The debate is how closely the superimposed images represent the actual position of suspicious areas. The superimposition is done by a combination of computer software and urologist tweaking. It is possible that tissue has changed position between MRI and fusion biopsy.

The fusion biopsy is a concession to cost and convenience (whose convenience?).

My conclusions were that the MRI and in-MRI biopsy (if indicated) should be done by a highly experienced radiologist who was a diagnostic specialist (not involved in treatment).
Posted 2/12/2018 6:53 PM (GMT 0)
My husband had CT scans before his biopsy - his PSA was 74 - and they found bone mets and enlarged lymph nodes. A MRI guided biopsy was done for both prostate and lymph nodes in December 2016. Because they had the guided biopsy the radiologist only took 5 cores. Only three were biopsied (100%), one was saved for further genetic testing and the other one was for a research project.
Posted 2/12/2018 8:27 PM (GMT 0)

JeffM said...
Hi Crazy,

If I recall correctly, your husband is getting the MRI at Duke, correct? Duke uses MRI-guided biopsy technology which utilizes the MRI images to guide the biopsy if it's needed. If the MRI shows suspicious areas, specialized software is used to guide the urologist to take biopsy samples from targeted areas of the prostate as opposed to just taking random samples.

You may want to read this:
/www.dukehealth.org/blog/improving-prostate-cancer-detection

The City of Hope in LA uses the same machine. The software generated by the MRI guides the biopsy device and the surgeon is only there to agree with the machine and click the ok button. I watched the whole thing on a screen. I thought it was very interesting. Not painful at all.
Posted 2/12/2018 9:11 PM (GMT 0)
Thank you for that information. He has the biopsy scheduled with his urologist (not at Duke) on Friday...just 3 days from the MRI. My understanding is that the urologist will use the images to assist in only biopsying the suspicious areas, should the MRI find any. So I guess that would be the fusion biopsy.

So, no way will any type of results be given tomorrow after the MRI? And when they are given on Thursday, they will most likely say "yes supsicious areas, or no suspicious areas"?

Just trying to prepare for our week. smile

Jenn


BOB 46 said...
There is a tendency for people to think of prostate MRI as a single well-defined concept. It is not.

First, there are differences in equipment. The "power" of MRI equipment is stated in TESLA units. 1.5T and 3T are typical. Higher is better, in that more detailed images can be obtained from more powerful equipment.

In addition, some practitioners have concluded that the use of 3T equipment can eliminate the need for the endorectal coil.

The term multi-parametric (MP-MRI) is used to denote that multiple types of images are produced which highlight different conditions.

Once the images are produced, they are analyzed by a radiologist. There is a wide range of experience/skill among radiologists. The radiologist must cross-correlate what is seen across the multiple image types to arrive at a conclusion. It is not a simple process. You want a highly experienced person to analyze the images.

The radiologist classifies what he sees into risk levels. Follow-on action depends on the level of risk observed.

If there are areas suspicious for cancer, biopsy is indicated.

There is a choice to be made as to who does the biopsy. It can be done by the radiologist in the MRI machine. This is the more expensive approach, since it involves time on the relatively scarce MRI machine. This approach allows the radiologist to observe the position of the biopsy needle relative to the suspicious area(s) without any distortion which may be introduced by the alternative methods.

The biopsy can also be done by a urologist using a technique know as fusion. The MRI images are imported to a separate machine, typically located in the medical office of the urologist. The urologist machine presents an image of the way things appear now. The MRI images, presenting the way things were in the past, are superimposed. The debate is how closely the superimposed images represent the actual position of suspicious areas. The superimposition is done by a combination of computer software and urologist tweaking. It is possible that tissue has changed position between MRI and fusion biopsy.

The fusion biopsy is a concession to cost and convenience (whose convenience?).

My conclusions were that the MRI and in-MRI biopsy (if indicated) should be done by a highly experienced radiologist who was a diagnostic specialist (not involved in treatment).

Posted 2/12/2018 9:16 PM (GMT 0)
Wow, thank you for that article. He is having the MRI at Duke tomorrow...and the biopsy at his urologist office on Friday, not affiliated with Duke. So, this MRI is able to detect suspicious areas and any that may have spread beyond the prostate, yes?

JeffM said...
Hi Crazy,

If I recall correctly, your husband is getting the MRI at Duke, correct? Duke uses MRI-guided biopsy technology which utilizes the MRI images to guide the biopsy if it's needed. If the MRI shows suspicious areas, specialized software is used to guide the urologist to take biopsy samples from targeted areas of the prostate as opposed to just taking random samples.

You may want to read this:
/www.dukehealth.org/blog/improving-prostate-cancer-detection

Posted 2/12/2018 10:41 PM (GMT 0)

CrazyLady said...
Thank you for that information. He has the biopsy scheduled with his urologist (not at Duke) on Friday...just 3 days from the MRI. My understanding is that the urologist will use the images to assist in only biopsying the suspicious areas, should the MRI find any. So I guess that would be the fusion biopsy.

So, no way will any type of results be given tomorrow after the MRI? And when they are given on Thursday, they will most likely say "yes supsicious areas, or no suspicious areas"?

Just trying to prepare for our week. smile

Jenn


Gupta was the radiologist who read my MRI at Duke. He is mentioned in the article Jeff referred you to. I called him, asked him to do it personally, and to call me with the results that afternoon, which he did. I dont like waiting. If your urologist referred you to Duke you may have to ask the radiologist to call your urologist then have the urologist call you with the results. I am fortunate to have a urologist who doesnt mind if I call him at home.

Posted 2/12/2018 11:05 PM (GMT 0)
I also don't like waiting!
My husband is supposed to call his urologist on Thursday to discuss the MRI results. Again, all we will know from the MRI is whether or not any suspicious areas are found, correct?
Thanks for all of the information.
Jenn


hrpufnstuf said...

CrazyLady said...



Gupta was the radiologist who read my MRI at Duke. He is mentioned in the article Jeff referred you to. I called him, asked him to do it personally, and to call me with the results that afternoon, which he did. I dont like waiting. If your urologist referred you to Duke you may have to ask the radiologist to call your urologist then have the urologist call you with the results. I am fortunate to have a urologist who doesnt mind if I call him at home.

Posted 2/13/2018 12:53 AM (GMT 0)

CrazyLady said...
I also don't like waiting!
My husband is supposed to call his urologist on Thursday to discuss the MRI results. Again, all we will know from the MRI is whether or not any suspicious areas are found, correct?
Thanks for all of the information.
Jenn


Basically, yes. The radiologist will also report other findings such as any evidence of prostatitis, BPH, size of the prostate, any evidence of hernia, etc.

Posted 2/13/2018 3:57 AM (GMT 0)

CrazyLady said...
So, this MRI is able to detect suspicious areas and any that may have spread beyond the prostate, yes?

The unfortunate truth is that all existing technologies fall far short of detecting all instances of cancer spreading beyond the prostate.

If the MRI analysis indicates biopsy, and biopsy detects high risk conditions, current standard of care calls for a pelvic/abdominal CT scan and a bone scan. Even these scans are unable to detect the small to microscopic clusters of cells that are the beginning of metastasis.
Posted 2/13/2018 4:44 AM (GMT 0)
My biopsy did not detect any spread outside the capsule. But my surgeon using RARP says he can detect cancer cells outside the capsule as they are sticky and want to stick to the instruments. He cuts wider till he finds normal tissue. He is very experienced with the robotic machine. I am told in open surgery the experienced URO can feel the difference in healthy tissue. With robotic there is no feel. He just needs lots of experience and have had a good dr to mentor. An experienced URO will have been second on the machine for at least 200 operations.
Posted 2/13/2018 4:50 AM (GMT 0)

CrazyLady said...


So, no way will any type of results be given tomorrow after the MRI? And when they are given on Thursday, they will most likely say "yes supsicious areas, or no suspicious areas"?

I went to a practice that did diagnostics only, no treatment. They were set up to provide a face-to-face meeting the same afternoon as the MRI was done. This is completely atypical.

The radiologist will write a detailed report describing his findings and conclusions. You should obtain and retain a copy of this report.

In your original post, you said "based on those results, they will do a biopsy or not".

Several minutes later in another post, you said "so the MRI is to get a better view of his prostate, and from there the urologist will know exactly what areas to biopsy".

I would not commit to any further action (including biopsy) before reading that report and having full understanding of its meaning (from the radiology practice, not the urology practice).

Beware of over-treatment by urologists.
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