Any point in getting a second opinion on 3T enhanced MRI reading?

MRI negative

Have standard 12 core biopsy scheduled in three weeks.

Would prefer targeted biopsy, but with negative report on MRI, don't see how anything is there to target.

PCA 49
PHI 43.9

Indicates something going on.

Have not yet had a biopsy, and Dr recommended get it so I thought time to get it done.

Anybody think I ought to try for a second opinion on the MRI? If so, where?

Or other comments?

I think I'm on a pretty good track for the moment, will see how the standard biopsy works out. If no results there, can hop a plane to Color Doppler TRUS.

At this point, I have learned a lot, read a lot and am mildly concerned that I am overthinking it.

Thanks

Ken

When I made the mistake of getting an unnecessary bone scan, but one that showed false positives, the scans were sent to Fabio Almeida in Phoenix for a 3rd (and negative) opinion. Mine weren't MRI (CT or PET?) but he might be able to offer an opinion on your MRI.

sheepguy said...
...6.5 at age 49...

DOB 1946

Edited sig for clarity

Tall Allen said...
Ken-Was it a 3T mpMRI (or a 1.5T w endorectal coil) or just a normal one? If an mpMRI,who did the PIRADS evaluation, what was the PIRADS score, and what are his qualifications/experience?

It was a 3T "Multiplanar", Multisequence, without and then (last five minutes) with gadolinium contrast.

No mention of multiparametric or PIRADS.

Findings:

PROSTATE SIZE: the gland measures 6.0 x 5.4 x 5.0 cm.

Peripheral Gland: there is only minimal decreased T2 signal Medial bilateral prostate base without associated enhancement or diffusion abnormality and may represent sequelare of fibrosis. No focal nodule.

Central Gland: there are T2 hyperintense nodules in the central gland consistent with hypertrophy.

....Everything else was basically boilerplate verbage normal Capsule intact, seminal vessels, bones, bladder, rectum - all normal

Edited to add - The Uro looked at the name of the radiologist and said he was the best one they had on staff and that he had done a fellowship in MRI at a big name that escapes me at the moment. Also, this hospital doesn't at this time have the equipment to 3T mp MRI targeted Biopsy.

I do like the urological oncologist I am workng with though. He listens to me, responds, makes sure I understand what he says and does not seem in the slightest offended that I am taking an active part in the process. Plus, he has over 1,000 robotic prostate surgeries and over 500 robotic surgeries under his belt and appears pretty knowledgeable.

Ken,
Another option is to get a transperineal template mapping biopsy. They take 20-30 cores from all over the gland. It's the gold standard for biopsies. I agree with you that because PHI and PCA3 are both elevated (although not extraordinarily high), you are right to be suspicious.

- Allen

Slept on this, and think my next step is to go for a 3T, mp MRI and/or targeted biopsy at some place I can be comfortable with the reading of the MRI. Prior to the MRI, I did ask the scheduler if the MRI was 3T and was told yes, and asked if multiparametric and was told yes. I now think she didn't understand the question.

Learning that I will need to be more specific in my questions, ask what machine is being used, ask who will be doing reading, PIRADS score, etc.

I am glad to know about the mapping biopsy, in the event that looks like it is needed.

At this point, the more information I can gather with less invasive procedure the better.

Going to cancel the standard 12 core biopsy, thinking there is too much chance of it missing something.

While PCA3 and PHI scores are suspicious, they are in a range which appears to me as unlikely to be urgent as relates to timing. Taking time to find the appropriate path should work well.

I am in Greenville, SC, about halfway between Atlanta and Charlotte.

Puts me about 3.5 to Duke.

After seeing one of your posts in a recent thread Friday, I called Duke and learned they no longer do mpMRI targeted biopsy, and now Dr Polascik does only the Fusion Biopsy.

I also called Emery in Atlanta Friday afternoon, and their telephone receptionists and system seem unable to normally do anything other than set an appointment and after some discussion put me thru to a staff members voicemail who hopefully will return my call sometime the first of the week. Emery is about two plus hours away, with the plus often being a good bit worse due to timing of traffic and how close to rush hour.

In reality, I am leaning a good bit more towards Duke due to better reputation, and I don't mind three and a half hours consistently (although at times I-85 and I-40 slowdown also)

I meant to send you an email last night, and got tied up. Will send you one now.

Thanks, Tall Guy

I have yet to have a biopsy, but figure the MRI reader at Duke may see something that was not resolved by the previous radiologist.

I do figure it is time to get a biopsy, and if the Fusion is done transperineally with less risk of infection I'm thinking that may be better, anyhow.

ETA - as for now, this is looking like my next best step to get a proper diagnosis.

Post Edited (Ken) : 10/3/2015 1:01:38 PM (GMT-6)

Dr Gupta is the radiologist at Duke who read my MRI and collaborates with Dr Polascik for the MRI and fusion biopsy if needed. They have published several papers together and have a relationship that I think is probably beneficial to their patients. I asked for Dr Gupta to read my images personally and he agreed. He also agreed to call me personally before calling my doctor. I do not like to wait for results. He did call within 2 hours after the MRI. I called him a few days later for additional clarification and he called me back at the end of his day. Polascik is not nearly as personable and approachable but probably a fine doctor. I think he knows his stuff and has excellent credentials. I would go back without reservation if I had too. Email me if you want more information.

appreciate the email hrpufnstuf.