Mri scans prostate check

[Sheryl]

22 hours ago, HauptmannUK said:

In the UK the NHS are now recommending an advanced kind of MRI (multiparametric MRI - mpMRI) if PSA is elevated - rather than biopsy. mpMRI has some advantages over biopsy and ultrasound. The resulting image is scored on a PI-RADS scale of 1-5 to indicate the likelihood of cancer. mpMRI requires a more powerful MRI machine and these are being installed in hospitals in the UK.

https://prostatecanceruk.org/prostate-information/prostate-tests/mri-scan

 

Couple of years ago my PSA was a bit high and my GP recommended mpMRI scan - he said biopsy is unpleasant and carries risks of infection. My mpMRI came back with a score of 2 (low risk of cancer) and BPH was diagnosed. PSA subsequently dropped back down.

mpMRI is not al alternative ti biopsy - if its results are suggestive of a malignancy, biopsy still must be done

 

What mpMRI can do is  help determine if biopsy is needed, with more precision than ultrasound & DRE alone, and this avoid some unnecessary biopsies. And, at least as or mote important, mpMRI cna be used to guide placement of the biopsy needle.  A big problem with prostate biopsies is that if the right location is not sampled, it is easy to get a false negative.

 

But as explained, mpMRI is nto yet widely available in Thailand. 

[actonion]

Now at the age of 75 i was hoping i was coming to the end of Prostate checks, as the Urologist in the UK said  after the age of 75   there is no point in further checks ..

 

Having been for  what i thought was my last check at BPH  the Urologist there said in Thailand  the cut off  for checks  age is now  80......I do have an enlarged prostate,  and a PSA number just under 2, not sure if i should  keep  the checks going  as the Thai doctor said I  should.....

[LosLobo]

10 hours ago, KhaoYai said:

I believe that most cases of prostate cancer are very slow moving - there's a saying that you die with it, not of it.  In such cases the treatement is usually 'watchful waiting' (continual monitoring).  I'm not a doctor but to the best of my knowledge a doctor cannot determine the grading of the cells - Gleason Score without a biopsy. As you've had a biopsy I presume your cancer was graded?  If so it was probably determined as low grade and not requiring immediate treatment. Was your doctor recommending regular MRI's?  I guess that would establish the size and any growth of the tumour(s) but its not something that's usually done here in the UK or it wasn't when I was diagnosed - The first steps are continual monitoring and as the progress increases you may well be recommend to have hormone therapy. I've not heard of MRI's being used as part of that regime but I suppose its possible that they newer type of MRI could be useful.  Just be sure your doctor worked out your Gleason Score.

In Australia, I am on active surveillance. I have PSA 10 and Gleason 6.

 

My regime is  PSA test 6 monthly, Pm MRI yearly and biopsy 2-3 yearly.

 

Recently had a CT PSMA PET scan to check capsule leakage only because it was a half price special ????

I am not concerned most men die with prostate cancer not from it.

 

"Active surveillance may be suggested for prostate cancers with a PSA level under 10 ng/mL, stage T1–2, and Gleason 6 or less (Grade Group 1 and some Grade Group 2). About 70% of Australians with low-risk prostate cancer choose active surveillance.

Active Surveillance for Prostate Cancer | Cancer Council NSW

Edited May 13, 2022 by LosLobo

[KhaoYai]

5 hours ago, Sheryl said:

There is no reason at all to get a biopsy based solely on an enlarged prostate -- almost all  older men have an enlarged prostate.

I'm not saying there is. But an enlarged prostate + an above normal PSA - I would definitely say there is but that is of course - a personal opinion.  I understand the risk of infection posed by biopsies but at the moment there is no other way of a.) absolute confirmation of malignancy and b). grading tumours.  Perhaps I've been lucky - I've had 3 biopsies, 2 standard and 1 guided perineal without problems.  The perineal is obviously more involved and requires an anaesthetic but carries less risk of infection. However, from what I've read the newer type of MRI scan reduces the need for biopsies.

 

My brother-in-law was diagnosed with an enlarged prostate around 10 years ago and was told it was nothing to worry about on at least 3 occasions.  Last year he had a change of GP and discussed his prostate problems during an appointment for another matter.  His new GP was concerned and wrote to the Urology department of our local hospital requesting a biopsy. Long story short, although his PSA was much lower than mine (14 from memory) - the biospy and subsequent scans revealed his cancer was far worse than mine - it had broken through the capsule and was present in several lymph nodes.  He is therefore, outside the criteria for curative treatment and is now on hormone therapy to slow the progress of the disease.  The only other option he has for treatment is chemo but with PC, that on its own is not curative and in the UK, is either administered to compliment other treatments as part of a curative treatment plan or on its own to reduce symptoms in the final stages.

 

Far too many men are dying from this disease because they either ignore symptoms, are unaware of them or are misdiagnosed because a biopsy has not been carried out.  In the UK there is no screening programme because of the amount of people who's PSA tests high, are recommended for a biopsy and are subsequently found not to have the disease but have been exposed to infection. 

 

PSA + Biopsy may carry risks as a method of testing for PC but as yet we don't have anything better (although the new MRA scans are improving things).  Whilst a very high PSA level like mine indicates a very high likelihood of PC, a lower PSA does not always mean theHaving stood in a doctors office and told the results - which felt like being shot in the head, I will always advocate biopsies until there is a definitive altrenative method of checking for malignancyre is no PC - as evidenced by my brother-in-law's case.

 

I believe that PET scans are very reliable - they pinpointed the site of very small recurrence with me which was then confirmed by a perineal biopsy.  The results were then used to accurately map sites for brachytherapy. I have no idea why PET scans are not used in initial diagnosis and can only guess its because of the cost.

 

Having stood in a doctors office, given my results and told I had 2 - 4 years left (which felt like being shot in the head), I will always advocate biopsies until there is a definitive alternative method of checking for malignancy.  Thankfully I responded to my treatment plan better than most and I'm still OK 7 years later.  I had the aggresive form of the disease yet I know of others that had the less risky grade but are sadly no longer with us.

 

Knowing what I know now - if I didn't already have the disease I'd be knocking on my GP's door and demanding a PSA test every year. Depending on the results I would decide on whether a biopsy is needed or not - not my GP. Fortunately my GP is very pro-biopsy so that would not be necessary.

 

Risk of infection -vs- risk of death is a no brainer for me but everyone should take control of their own health and make that decision.

 

 

 

 

[LosLobo]

21 hours ago, KhaoYai said:

I have no idea why PET scans are not used in initial diagnosis and can only guess its because of the cost.

The mpMRI has some advantages over the PSMA PET scan for initial diagnosis. Both scans would be the better option. But then again there is the added process and cost.
 

"The MRI component is the imaging modality of choice for precise morphologic evaluation and has higher spatial resolution and provides clearer anatomic delineation of the prostatic fossa and surrounding anatomical structures than PET 16, while PSMA PET is the superior modality for detecting metastases to the locoregional and extrapelvic lymph nodes, bones and visceral organs ."

 

"Consequently, PSMA PET/MRI yields greater diagnostic accuracy for PCa localization than multiparametric MRI (mpMRI) or PET alone. These encouraging data indicate that hybrid imaging using morphologic, functional, and molecular information enhances diagnostic performance in patients with PCa for TNM staging 14".

 

Clinical perspectives of PSMA PET/MRI for prostate cancer - PMC (nih.gov)

 

Edited May 14, 2022 by LosLobo

[BKKKevin]

On 5/11/2022 at 11:52 PM, Sheryl said:

Parametric MRI is available in just a few places in Thailand (2-3 major government teaching hospitals) and very expensive. In additiojn only a handful of urologists here can interpret them.

 

Thus used here only when there is high suspicion of malignancy.

Hello Sheryl,

Could you name the hospitals that do Parametric MRI of the prostate?…

Do any of them specialize in MRI guided focal therapies?

Does Chiang Mai University have that capability?…

 

Thanks

[Sheryl]

8 hours ago, BKKKevin said:

Hello Sheryl,

Could you name the hospitals that do Parametric MRI of the prostate?…

Do any of them specialize in MRI guided focal therapies?

Does Chiang Mai University have that capability?…

 

Thanks

Last I heard, the o nly government hospitals in Thailand doing this were Siriraj (the first and probably the best for this), Chulalongkorn and maybe (not 100% sure) Chulabhorn. None outside Bangkok.

 

Among private hospitals, also AFAIK limited to Bangkok.

 

I would also mention that there is better expertise for management in Bangkok if the MRI suggests  malignancy.  And that urologists not trained in it would have difficulty using multi-parametric MRI results.

 

 

 

[Tropicalevo]

On 5/12/2022 at 11:21 AM, chilli42 said:

Exactly my experience as well.  I am not sure why they would want to do an MRI for prostate 

The answer to that one is simple.

 

As explained to me by a doctor friend.

If your doctor suggests a biopsy to 'look and see' if you have cancer, an MRI scan, carried out periodically is much safer.

A biopsy puts wounds in your prostate. If you do have cancer, then these wounds can allow the cancer to spread further, more quickly.

MRI first and then if anything is spotted - go for the biopsy (targetted).

[Sheryl]

1 hour ago, Tropicalevo said:

The answer to that one is simple.

 

As explained to me by a doctor friend.

If your doctor suggests a biopsy to 'look and see' if you have cancer, an MRI scan, carried out periodically is much safer.

A biopsy puts wounds in your prostate. If you do have cancer, then these wounds can allow the cancer to spread further, more quickly.

MRI first and then if anything is spotted - go for the biopsy (targetted).

Not only is it safer to get MRI firts, but the odds of a biopsy finding cancer if it is present, is greater.

 

A biopsy samples only a small amount of prostate tissue and in early prostate cancer it is entirely possible for biopsy to be negative simply because the sample was nto taken from the right spot.

 

 

[KhunBENQ]

1 hour ago, Sheryl said:

Among private hospitals, also AFAIK limited to Bangkok.

Unfortunately I can not remember the exact term of what has been done on me at Bangkok Hospital in Khon Kaen (end of July this year). But it was some specialized MRI for the prostate coming with a formalized result in the range of 1 to 5. I was 3 and cancer not too likely.

Procedure was almost 2 hours and quite exhausting and a whopping 16k Baht.

After that TURP was done. Fine so far.

Edited December 26, 2023 by KhunBENQ

[Tropicalevo]

50 minutes ago, KhunBENQ said:

After that TURP was done. Fine so far.

Aargh. I am jealous.

Had the TURP in October and now have scarring inside the tip of the penis. Urinating is very difficult.

Still trying to resolve that one.

[DaLa]

Presently having treatment for PC.  Started with a general check up in early September revealing a PSA of 24 , so then the finger test a week or so later. Possibility of Cancer was explored with an MRI at Srisawan private hospital on Rattchapreuk Road , cost 22k (ish). Then  I reported back to the original urologist in Siriraj and with that further confirmation I opted for a Biopsy, (55k -private room). Was feeling ok after less than a day after the op, no problems and then the results...a Gleeson 9 and had to act quick. The location and size was then further confirmed by a PET at Siriraj (50k) and then  I opted for Radiotherapy rather than surgery; I'm 22 doses into 28 that will be another 300k.The LINAC  is the only one of its kind in SouthEast Asia and the care is 100%, so hoping for a successful outcome.  

 

Strange thing is I felt great in August before the diagnosis and unfortunately don't feel so good now due the side effects and the travelling (5 hours round trip). Furthermore I used to love drinking ordinary (filtered) tap water before the sessions started , now I feel queezy just thinking about the stuff, probably psychosomatic. 

 

Good luck and I'm not medically qualified to offer any advice on which route or treatment to take, all I offer is my own personal experience.

 

What I will say is that it would be useful if I'd been seen by my doctor in the UK earlier. Reception at my original doctor had a problem because I lived out of area and then the doctor I transferred to had a problem at reception due to me not using my middle name that I hadn't used for 60 years. No health check from the doctor but plenty of paper pushing.

[Sheryl]

33 minutes ago, DaLa said:

Strange thing is I felt great in August before the diagnosis and unfortunately don't feel so good now due the side effects and the travelling (5 hours round trip). Furthermore I used to love drinking ordinary (filtered) tap water before the sessions started , now I feel queezy just thinking about the stuff, probably psychosomatic.

More likely the (temporary) effects of the radiotherapy.

 

Can cause nausea/queasiness and defintely causes fatigue/general "icky" feeling. ALso clouded thinking.   These last 2 are usually linked to drops in blood ocunt.

 

It is important to see your doctor again if weakness etc increases for a repeat blood count even if last count was normal and not yet due for another test. I have seen patient's blood counts take a very sudden nose drive.  There are treatments that can be given for this.

[John49]

1 hour ago, KhunBENQ said:

Unfortunately I can not remember the exact term of what has been done on me at Bangkok Hospital in Khon Kaen (end of July this year). But it was some specialized MRI for the prostate coming with a formalized result in the range of 1 to 5. I was 3 and cancer not too likely.

Procedure was almost 2 hours and quite exhausting and a whopping 16k Baht.

After that TURP was done. Fine so far.

 

Sounds like the “MRI of Prostate Gland” that I had done at “PC Imaging Center” in Bangkok a few months ago.

It cost 15,500 baht and included a contrast injection.

The machine was a 1.5 Tesla.

Someone commented earlier that this machine is not sufficiently advanced (or something like that) and a Tesla 3.0 machine (with coil?) should be used for a more reliable result.

 

I did a ‘copy and paste’ from my report – "Assessment Categories" shown below.

 

I was RADS-3 (in bold print below).

 

Some weasel wording here - “Equivocal”, meaning cancer may be present, or cancer may not be present.

 

PI‐RADS v2.1 Assessment Categories

PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present)

PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)

PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4 – High (clinically significant cancer is likely to be present)

PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present)

 

 

[simple1]

@sheryl is  PSMA-PET scan available in Thailand as It's the gold standard for identifying prostate cancer in the body.

[Sheryl]

1 hour ago, simple1 said:

@sheryl is  PSMA-PET scan available in Thailand as It's the gold standard for identifying prostate cancer in the body.

Not the "gold standard" and not often done, anywhere, due to very high cost.

 

And not available in Thailand AFAIK. It was approved in the US only 3 years ago so very new.

 

Scans of any sort cannot conclusively diagnose cancer, that needs a biopsy (in the case of the prostate, preferrably MRI guided)

[simple1]

13 hours ago, Sheryl said:

Not the "gold standard" and not often done, anywhere, due to very high cost.

 

And not available in Thailand AFAIK. It was approved in the US only 3 years ago so very new.

 

Scans of any sort cannot conclusively diagnose cancer, that needs a biopsy (in the case of the prostate, preferrably MRI guided)

 

FYI my oncologist, in Australia,  uses PMSA-PET scan to identify location of prostate cancer in the body, not MRI

[chilli42]

20 hours ago, Tropicalevo said:

The answer to that one is simple.

 

As explained to me by a doctor friend.

If your doctor suggests a biopsy to 'look and see' if you have cancer, an MRI scan, carried out periodically is much safer.

A biopsy puts wounds in your prostate. If you do have cancer, then these wounds can allow the cancer to spread further, more quickly.

MRI first and then if anything is spotted - go for the biopsy (targetted).

 

[Ben Zioner]

17 hours ago, John49 said:

 

Sounds like the “MRI of Prostate Gland” that I had done at “PC Imaging Center” in Bangkok a few months ago.

It cost 15,500 baht and included a contrast injection.

The machine was a 1.5 Tesla.

Someone commented earlier that this machine is not sufficiently advanced (or something like that) and a Tesla 3.0 machine (with coil?) should be used for a more reliable result.

 

I did a ‘copy and paste’ from my report – "Assessment Categories" shown below.

 

I was RADS-3 (in bold print below).

 

Some weasel wording here - “Equivocal”, meaning cancer may be present, or cancer may not be present.

 

PI‐RADS v2.1 Assessment Categories

PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present)

PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)

PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4 – High (clinically significant cancer is likely to be present)

PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present)

 

 

You need a biopsy, the lesions revealed by the MRI will be targeted, but they will also do some random sampling. If a small gleason 6 tumour is revealed just go on AS. Happened to me 6 years ago.

[elektrified]

On 12/26/2023 at 12:52 PM, Sheryl said:

Last I heard, the o nly government hospitals in Thailand doing this were Siriraj (the first and probably the best for this), Chulalongkorn and maybe (not 100% sure) Chulabhorn. None outside Bangkok.

 

Among private hospitals, also AFAIK limited to Bangkok.

 

I would also mention that there is better expertise for management in Bangkok if the MRI suggests  malignancy.  And that urologists not trained in it would have difficulty using multi-parametric MRI results.

 

 

 

Hi Sheryl,

At CMU (Sriphat) there is a new imaging center that offers Tesla 3 multi-parametric MRI scans. I had one of my prostate in February of 2023.

[xylophone]

Intersting info on prostate cancer treatment........just for info but looks promising! Hope for the future.

 

Could men with advanced prostate cancer avoid chemotherapy?

Radioligand therapy offers a potential alternative. But only approved for certain cases.

When we think about radiation therapy, we typically picture treatments directed at tumors by a machine located outside the body. Now imagine a different scenario — one in which radioactive particles injected into the bloodstream find and destroy individual cancer cells, while leaving healthy cells unscathed.

The drug

One such "radioligand" is already available for certain patients with prostate cancer. Called Lu-PSMA-617 (trade name Pluvicto), it carries a lethal payload of radioactive atoms. The drug binds with a cell protein known as prostate-specific membrane antigen (PSMA), which is abundant on most prostate cancer cells but absent on most normal cells. After sticking to that protein, Lu-PSMA-617 delivers its radioactive cargo, and then the targeted cell dies.

https://www.health.harvard.edu/blog/could-men-with-advanced-prostate-cancer-avoid-chemotherapy-202401083005

[BKKKevin]

On 1/1/2024 at 8:53 AM, elektrified said:

Hi Sheryl,

At CMU (Sriphat) there is a new imaging center that offers Tesla 3 multi-parametric MRI scans. I had one of my prostate in February of 2023.

Can you give the name of the doctor you initially consulted at CMU that arranged the Multi Parametric MRI for you?

Edited January 9 by BKKKevin

[elektrified]

On 1/9/2024 at 8:50 PM, BKKKevin said:

Can you give the name of the doctor you initially consulted at CMU that arranged the Multi Parametric MRI for you?

I booked it myself. Nobody arranged it for me.

[BKKKevin]

4 hours ago, elektrified said:

I booked it myself. Nobody arranged it for me.

Curious…

What was the cost?

Did it include a review and opinion by a MRI diagnostic oncologist?

Were you able to identify a specific lesion or an area with high level prostate cancer?

Did you have a traditional biopsy before or are you using this for a targeted biopsy?

Do you have a urologist specialist doctor that will accept and review this third party MRI?

 

Edited January 10 by BKKKevin

[elektrified]

12 hours ago, BKKKevin said:

Curious…

What was the cost?

Did it include a review and opinion by a MRI diagnostic oncologist?

Were you able to identify a specific lesion or an area with high level prostate cancer?

Did you have a traditional biopsy before or are you using this for a targeted biopsy?

Do you have a urologist specialist doctor that will accept and review this third party MRI?

 

I'll have to look for the bill, but it was cheaper than the Tesla 1.5 MRI at Suan Dok (>5 years ago)

The only review (radiology report) included was by a Radiologist from the CMU Faculty of Medicine

The Radiologist upgraded me from PIRAD-4 (old Tesla 1.5) to PIRAD-3 which was a big relief

I've had two biopsies in the past; 6 and 10 years ago. Both negative for cancer. This new Tesla 3 technology can be used for an MRI guided biopsy, but in my case, turned out to not be necessary

If the MRI is taken at the new Sriphat Imaging Center, then all urologists within the CMU Faculty of Medicine, both public and private wings will accept the MRI. They will not entertain MRI's taken outside of the CMU network

 

[BKKKevin]

2 hours ago, elektrified said:

I'll have to look for the bill, but it was cheaper than the Tesla 1.5 MRI at Suan Dok (>5 years ago)

The only review (radiology report) included was by a Radiologist from the CMU Faculty of Medicine

The Radiologist upgraded me from PIRAD-4 (old Tesla 1.5) to PIRAD-3 which was a big relief

I've had two biopsies in the past; 6 and 10 years ago. Both negative for cancer. This new Tesla 3 technology can be used for an MRI guided biopsy, but in my case, turned out to not be necessary

If the MRI is taken at the new Sriphat Imaging Center, then all urologists within the CMU Faculty of Medicine, both public and private wings will accept the MRI. They will not entertain MRI's taken outside of the CMU network

 

Great News for you!…

Are you considering a focal therapy for your PIRADS 3 Lesion?…
Please do get back with the cost as I am on the same path as you…

Thanks

Edited January 11 by BKKKevin

[Ben Zioner]

On 5/12/2022 at 5:51 AM, TheFishman1 said:

And my yearly check ups they do an ultrasound to check prostrates

You mean prostrated patients? Is this some skeletal-muscular disease?

[elektrified]

On 1/11/2024 at 8:45 PM, BKKKevin said:

Great News for you!…

Are you considering a focal therapy for your PIRADS 3 Lesion?…
Please do get back with the cost as I am on the same path as you…

Thanks

No, I don't have prostate cancer. I had prostatitis at the time of the MRI. But that has been treated.

[voyagerUSA]

On 1/1/2024 at 9:53 PM, elektrified said:

Hi Sheryl,

At CMU (Sriphat) there is a new imaging center that offers Tesla 3 multi-parametric MRI scans. I had one of my prostate in February of 2023.

 

On the issue of mpMRI for prostate it seems BNH Hospitals offers a special package for 18,000 bhat