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Posted 5/31/2013 1:02 AM (GMT 0)
Although it does not really matter now, I have had a lingering question about my husband's MRI. Before his surgery he had an MRI done which did not show any ECE, yet after surgery his pathology report showed one area of EPE. I think that the area of EPE was near the seminal vesicles. Does anyone know why this would not show up on an MRI. The MRI was done at New York Presbyterian, which is an excellent hospital, so I assume they would have a top notch radiologist reading the MRI.

If we had known, it probably would not have made any difference in my husband's choice of treatment. Since he had urinary symptoms we were afraid to do radiation as a primary form of treatment. My husband had clear margins but the EPE was a surprise to us.
Posted 5/31/2013 1:50 AM (GMT 0)
The typical 1.5 Tesla MRI does not have the resolution to show anything but fairly large bulges. 3 Tesla is better. Endorectal coils are even betterer. Multiparametric MRIs on a 3T machine with endorectal coil read by an expert radiologist is the best.

I guess the thinking is that if there is no obvious extension, it is probably still localized and an RP can effectively treat it.
Posted 5/31/2013 2:03 AM (GMT 0)
I believe that bluebird's husband had the endorectal coil. (Not sure about the multiparametric part.) I say that because I use the same doctor and had the MRI at the same hospital, and that's what was done for me.

-Gedman
Posted 5/31/2013 2:09 AM (GMT 0)
On his MRI report it says:

Technique: MRI of the pelvis with and without intravenous contrast with endorectal coil.

The MRI report also says:
.......No evidence of extracapsular extension of disease.....

As Gedman indicated, I am not sure what type of machine it was though.

Thanks, Tall Allen.
Posted 5/31/2013 2:23 AM (GMT 0)
My 3T MRI with and without contrast diffusion weighted imaging pretty clearly showed extracapsular extension. The reading says, "Abnormal signal and contrast enhancement in the base and mid segments of the peripheral zone of the prostate, predominantly on the left in the 2:00 to 6:00 axes, with an appearance that is suggestive of left posterior extracapsular extension with possible neurovascular bundle involvement by adenocarcinoma."

So, the reading with a 3T MRI is pretty clear. I think what they can see definitely depends on the type of machine doing the scan. They gave me a copy of the images on a CD, and I can clearly see what the analyst was talking about.

(So, a bit concerning when it's all Gleason 9 and some 100% cores.)
Posted 5/31/2013 2:51 AM (GMT 0)
The overall sensitivity for detection of extracapsular extension (ECE) with MRI, even a 3T and endorectal coil, is best in intermediate and high risk cancers (higher pretest probability). Sensitivity for ECE is actually not that great with MRI. Specificity is much better. That is to say, MRI may well miss microscopic (few mm or less) extracapsular extension. However, if MRI is positive, ECE is very likely.
Seminal vesicle invasion accuracy with MRI is higher than accuracy for neurovascular bundle invasion and posterior ECE. It is entirely possible that a few mm or less of invasion could be not detectable.

Understand that all tests have false positives and negatives. Prostate MRI is no different.

Post Edited (starr15) : 5/30/2013 8:57:39 PM (GMT-6)

Posted 5/31/2013 1:46 PM (GMT 0)
Thanks starr15. That is another good explanation why the ECE was not detected.
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