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Looking for advice on upcoming MRI and Biopsy - 55 y/o with PSA: 12.8

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Posted 3/22/2016 12:00 AM (GMT 0)
Hey guys,

Am being treated at Massachusetts General Hospital. Have had a rising PSA for about 5 years now. Started at 1.8 and has risen to 12.8. DRE's have all been negative but latest points to an enlarged prostate. Had a biopsy in 2014 which was negative. Had an MRI last year which was negative. Urologist wants another MRI just in case there is a change, which he doubts there will be one, but if there is, he will be able to use the MRI image to guide the biopsy. Ether way, he is suggesting another biopsy to rule out various cancer possibilities.

My Urologist wants the MRI done at the hospital facility, partly because it will be easier for him to view and use for the biopsy, but partly I am sure because the hospital gets the business. My last MRI the Urologist ordered a coil to be used but the MRI doc's say they just stopped using coils (even though this facility gets most of the Prostate MRI's for MGH). Wasn't happy about that but my Urologist now says he is no longer ordering Coils since the results seem to be the same.

Sorry for the rambling, here is my question - should I go search out another MRI from another hospital system with different technology/equipment since the chances that this MRI will find something different seems low. My worry is that biopsy's are pretty much a needle in a haystack and a negative result doesn't really mean anything. Of course if they find something, I am not sure it will be able to be used for the biopsy but will be peace of mind to know. Have been reading about 4T MRI's and various other options.

Anyone out there have information based on their experience they can share?

Thanks so much!

Ken.
Posted 3/22/2016 12:31 AM (GMT 0)
If you indeed have an enlarged prostate 1. Are you taking anything like avodart to reduce it and 2. I would think a six core bx is too small a sample to catch any PCa . I've heard of 12 and even 32 core bx's.
Just sayin'
Bob
Posted 3/22/2016 12:59 AM (GMT 0)
Ken-

What kind of MRI are you talking about? It makes a difference. If you are talking about a 3T multiparametric MRI (which I assume you are), you should only do it where very experienced radiologists are available to read it, as at Mass General.

Your other option is to ask for a transperineal mapping biopsy. It's the gold standard, and it can take cores from places that are difficult to sample with a transrectal approach.

Have you had a PHI blood test or a PCA3 urine test? They may give you further clues as to whether your rise in PSA is due to PC or some other cause. Also, did your last biopsy note any areas of chronic inflammation? How big is your prostate?

- Allen
Posted 3/22/2016 1:46 AM (GMT 0)
Thanks for the feedback! Here is some additional info:

-Had a PCA3 which was negative. Was a 5, the scale starts a 4 and anything over a 25 is considered positive.

-Haven't heard of the PHI blood test. Just read up on it and will discuss with my urologist next time we speak.

-My urologist also said the radiologist is more important than the MRI technology and he thinks the radiologist doing the interpretation is the best. I'm a little paranoid that everyone at MGH thinks they're the best:) but they all really do seem to be good - so far. I read that Beth Isreal in Boston is using a 4T for prostate MRI's, which got me thinking if Mass General was using the latest technology.

-I'll call over to my urologist office and see if they are experienced in transpearineal mapping biopsy. I just started reading up on the differences in biopsy techniques.

-I didn't discuss any medication, not sure why this hasn't been at least mentioned.

- I don't recall my prostate size, the doc yelled it over to his assistant during my DRE. So truthfully, I had my mind a bit occupied:). My MRI in 2014 said my volumn was 5.6x4.7x4.2/2 cubic cm. Not sure how to interprete.

- I read my last biopsy report (probably just the biopsy results) and nothing abnormal was noted.
Posted 3/22/2016 6:25 AM (GMT 0)
That's a prostate volume of 58 cc. That gives a PSA density of .22, which is a little high for just BPH (average is .15) but is not that high. PHI is only available through certain urologists - you have to call to get a local list: www.myinnovativelab.com/prostate-cancer/

I wouldn't worry about a T4 vs a T3 - the magnetic field strength is only one of many factors in detection. The biggest factor is the radiologist and Mass General is well known for that.

- Allen
Posted 3/22/2016 4:28 PM (GMT 0)
"Your other option is to ask for a transperineal mapping biopsy. It's the gold standard, and it can take cores from places that are difficult to sample with a transrectal approach." T. Allan..

This is your best advise. Put your money here. MRI's are expensive and inconclusive....
Posted 3/22/2016 5:00 PM (GMT 0)
Sounds like you are uncomfortable with the way things are moving. Unfortunately the Urologist who did my biopsy has moved to Florida. I had great success (or failure - depends on your point of view) with a MRI Guided Biopsy. But my MRI had areas of concern and my PSA was higher. Fortunately we are both in Boston and have great options. Not providing much help hear but wish you luck with your decision.
Posted 3/25/2016 9:59 AM (GMT 0)
I did the 3T MRI which showed one lesion. Followed up with a 28 core transperineal biopsy (2 weeks ago) under general anesthetic (day surgery). It found a second cancer not shown on the MRI.
Went for a 3rd Eurol opinion yesterday.

............................
Age: 66
BPH 67cc's.
PSA 7.1
Gleason 7

Post Edited (shudderingThud) : 3/25/2016 4:06:21 AM (GMT-6)

Posted 3/25/2016 3:18 PM (GMT 0)
Don't worry about the MRI not using a coil. Most of the 3T MRI's use a heavy pad on your abdomen to replace what the rectal coil did. Johns Hopkins stopped using coils about three years ago.

Try to have at least a twelve core biopsy using a fusion image from the MRI to target suspicious areas. I think that a couple of additional cores are taken in those spots.
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