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Push for 3.0 Tesla mp-MRI?

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Posted 7/28/2014 4:48 PM (GMT 0)
Hi. DH is scheduled for surgery in mid-August. The surgeon has scheduled two pre-op imaging tests: a bone scan and an MRI. During our consult last week, I had asked about whether it was going to be a multi-parametric MRI and he said it was. When my husband talked to the scheduler at the surgeon's office this morning, he said that she had scheduled a "regular MRI with extra-capsular extension."

I don't know enough about these imaging tests. Is this different from the multi-parametric MRIs that are now being used so successfully? Also, I just checked the radiologist's website and they have only a 1.5 Tesla MRI, not a 3.0 Tesla. I thought that the stronger magnet (3.0) gave better pictures?

DH is willing to just let it go. His feeling is that we chose this surgeon because of his expertise and skill so we should trust his choice of imaging test. (I'm already skeptical about the need for a bone scan with a 1.7 PSA--but am willing to let it slide.) Should we push for the 3.0 T mp-MRI?

Any thoughts would be very helpful

Thanks,
Melaine

Post Edited (Melaine) : 7/28/2014 11:16:16 AM (GMT-6)

Posted 7/28/2014 5:14 PM (GMT 0)
DH now thinks that 3 Tesla is impt. But now I'm wondering which is more important: the power of the magnet or the expertise of the radiologist reading the results? Do we go with a 1.5 T mp-MRI here with someone who we know (or have heard) is an expert at reading prostate MRIs or go with the radiologist the surgeon has chosen, on a 1.5 T, and we know nothing about? Still push for the 3T?
Posted 7/28/2014 5:42 PM (GMT 0)
Melanie – IMO since you’ve picked your surgeon, you should follow his advice and get the imaging he has ordered. You are correct that the 3T produces clearer more detailed images, but you know the cancer is there, you’ve elected to have surgery, and DH’s numbers suggest the cancer is not extensive so perhaps the 3T is overkill at this point.

I also had only 1 of 12 positive cores, though my PSA was higher. My surgeon ordered an MRI before the procedure for two reasons: to see if there was any indication that the cancer had gotten out of the prostate capsule and to use the imaging to help guide him during the operation. I think he said it also helped him save the nerve bundles.

I was not aware of Tesla numbers back then, so I don’t know what kind of machine they used, but it was probably a 1.5T, because I’m not sure the 3T was available back in 2011. They did use the endorectal coil though.

-- Tigerfan
Posted 7/28/2014 5:51 PM (GMT 0)
Thanks Tigerfan,

Looks like you've had great PSA scores so congratulations!

So hard to know what to do. As a practical matter it doesn't look like there are any 3T MRI machines in the Seattle area--or if there are, it looks like they don't use them for prostate imaging. So no need to push it if we can't get that here anyway. Guess we'll go with what the surgeon has ordered.

Thanks for the quick reply!
Posted 7/28/2014 6:33 PM (GMT 0)
Melanie, with a low PSA the bone scan is most likely a waste of time...but some docs seems to like to have a base line. Re the MRI imaging, I expect others that are more expert than I will answer that.

Additionally, could you consider putting together a "signature" like many of us have? That makes it much easier for folks to respond when they know the background of the diagnosis or treatment.

Thanks,

Jim
Posted 7/28/2014 8:40 PM (GMT 0)
mpMRIs are good for detection of cancers in aiding biopsy. Your DH has gone past that point. This is the kind of MRI where radiologist expertise is especially important.

The purpose of the MRI his surgeon is asking for is different - he's looking for evidence of growth outside of the prostate capsule. If there is growth outside, surgery is a much less attractive alternative. 3T is more powerful than 1.5T, but they are just looking for obvious growth, so I agree with Tigerfan that 3T may be overkill just to do the staging. The surgeon will get the details when he goes in.

I agree with you and Jim that a bone scan is a waste, and it is not standard of care unless there are high risk characteristics.

- Allen
Posted 7/28/2014 9:51 PM (GMT 0)
Thanks for all your replies. I think I will leave it in the hands of the surgeon--although it's very hard to cede control.

Jim, if I've done it correctly, I have added a signature. (Thought I had one but maybe I was adding the info whenever I asked a question?)

You all are great!
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