Combidex scan in Holland!

Hello all fellow members with prostate cancer. Perhaps this is repetitive but people need to know this scan is a life saver. As it now stands however there is only the hospital in Nijmegen Holland where it is available. I had a radical prostatectomy in 2001 at the Mayo Clinic in Rochester Minnesota. For six years I was in remission. Then my psa became detectable. The problem: What to do? Radiation was the only option but not knowing where the cancer was made it improbable that it would succeed. To make a long story short, I saw a prostate cancer medical oncologist in Virginia, Dr. Charles Myers, himself a victim of prostate cancer.  I went to Holland, had the scan in the late spring of 2008, and the results showed four positive lymph nodes in my left groin. I began radiation treatments at the Dattoli Center in Sarasota Florida in early August 2008. So far my psa is not detectable. I know the combidex scan gave me a chance to live, without it I would have died. Dr. Barentz and his staff are very friendly and helpful. This is truly a miracle of modern medicine, and I would be very surprised if it didn't become standard practice here in the US. People are dying for lack of access to this proceedure.

 

The scan is just an MRI with a powerful Telsa 3 MRI; it the imaging agent that is not approved. The agent is Sirinium and is nano iron oxide particles that is given IV the day before the MRI. A cancerous lymphnode will not let the particles in, whereas an infected node will. The MRI picks this up as it images every node. The imaging agent is not approved anywhere and it is classified as experimental in Holland.
The agent is perfectly safe if given slowly, over an hour's time. If it is given faster it will cause back pain that goes away as soon as the IV is stopped.
The Combidex is 96% accurrate if it classifies the nodes as clear. There have been false positives; not anywhere close to prostascint. A single suspected node can always be biopsied to confirm PC, but if a string of nodes is positive you can be fairly certain it indicates PC. Dr Barantz and his assistant review every scan independently then compare their results. Every lymphnode is classified on a scale of 5 as to it's level of suspicion.
I had one node with a low suspicion level of 2. Because of its location and the low probability on the scan I was classified as being clear of lymphnode PC. It saved me from having to go on full blown HT and having my upper and lower lymphatic system radiated.
I don't know why the FDA is dragging their feet, but everyone I have talked to that has had the scan has found it very valuable as they were able to target the infected lymphnodes with radiation.
The same agent with size 20 nano particles is approved for use in detecting liver cancer. I think they use either a size 1 or 5 nano particles for PC.
Myers, Scholz and Strum routinely send their patients for Combidex scans. These are the only doctors in the US that do, but patients from all over Europe and Austrailia go to Holland for the scan. The cost is very reasonable at about $2500, far less than an MRIS, bone or CT scan which will add little to your DX.
None of my other doctors that were experienced in PC had ever heard of it.
JT

Very Interesting as I live in the Netherlands (and have done for over 25 years)


I had not heard or read of the Combidex MRI procedure until I saw this post. And have just been trying to read up a bit on the Internet (Fortunately I can read the articles in Dutch too!)



Maybe this is something that I will have to ask about in the future if my PSA doesn't get lower or doesn't stay down. I had my Da Vinci at the Antonie Van Leeuwenhoek Ziekenhuis-Nederlands Kanker Instituut in Amsterdam, (You can understand why it's called the AVL-NKI or even just the AVL)



I assume that the newness of this technique means it is still at the experimental stage and thus has to wait for a few green lights about its proven usefulness as a diagnostic tool (and safety) before it is unleashed.

And in addition to the equipment and procedure being given the okay, there will also be a need to give doctors who may want to use this elsewhere adequate training to interpret the images correctly etc before having it all to themselves (it seems that at present Dr Jelle Barentz does all the analysis himself.)





We seem to find ourselves right in the middle of a mini quantum leap in new treatments and diagnostics etc fro PCa



Alfred

Not to crack holes in the conspiracy theory, but Combidex (ferumoxtran-10) has well publicized issues. In fact they are attempting to develop a new agent that will hopefully improve the accuracy of the test. In the attached link and study, 19.6 percent of patients in the study showed clear lymph node invasion. But only 75% of those were confirmed positive during biopsy after the Combidex scan and a whopping 24% were inaccurately diagnosed with false positives in the lymphatic system. I believe that Combidex is a good test, but it's accuracy rivals the PSA test.

prostatecancerinfolink.net/2009/06/17/combidex-mri-and-identification-of-nodal-metastases/

Tony

Thanks John T. you do know alot about this proceedure, enough so that you know the arguements that are discussed. Years ago Dr. Strum mentioned that this was 'the best'(or most definitive) scanning method that was available to us patients(he admitted, also it is not perfect), does not surprise me. He is amongest the better informed oncologists on PCa on any level, his book speaks for him as of his expertise.

John how old is proceedure now by Dr.B, like 10 yrs????? Is is not brand new and has a track record. You can inform us some more on this, it would be worth listening to as our current scanning methodology is lacking.

There aren't any perfect tests. I've argued with some doctors who are ignorant enough to suggest psa screening tests for their patients aren't helpful because "there's too many false positives". My reply was: Dr. if you had the cancer, you might feel differently", that got a negative response as well, "I don't want to talk about it anymore". If you're getting the run around, go see a real specialist like those mentioned here. I had a gleason 9 tumor post surgery with a psa of 2.5 (the day of surgery)  and clean margins per the path report at Mayo. I almost went for radiation following surgery, it was all set up, then I cancelled it. Who knows what would have happened if I had the radiation as planned.

All I know for sure is when I needed to know where the cancer was located, the combidex scan shone clear and true. Without it I would be a dead man walking.