Where is "Bangkok General" (Prostate MRI)

[elektrified]

I've had high PSA numbers for a couple of years now, diagnosed with BPH. I had a prostate biopsy at C.M. Ram about 2 years ago which was negative. However the PSA numbers are still high. I take a PSA test every 3 months and take a medicine called Alfuzosin XL. Recently my doctor has mentioned the possibility of having a MRI of the prostate taken to see what is going on. He said that it is no longer available in C.M. because the entire staff who did the procedure here, quit to go work in Bangkok. So he said I would have to go to "Bangkok General" to have it done and that it would cost somewhere around 20K Baht. I've google searched but don't see a "Bangkok General". I'm guessing that is a nickname used by medical professionals of a certain BKK Hospital?

 

Also, has anyone had the prostate MRI? What did you discover that was not found in the biopsy?

Edited November 19, 2016 by elektrified

[Sheryl]

Bangkok General is the former name of Bangkok Hospital

http://www.bangkokhospital.com/index.php/en

 

It is not to be expected that PSA will decrease with treatment using Alfuzosin as it just provides symptomatic relief by helping to relax the walls of the bladder and urethra, it does not reduce prostate size.  (There are other drugs used in BPH that can, but not alfuzosin and others in its family). As long as the PSA is  under 10 and staying about the  same, or showing only very small and slow increases, this is not in itself a cause for concern.  Rapid increase and levels 10 and over, though, are another story.

 

I am a little surprised at the recommendation for an MRI. Have you already had an transrectal ultrasound? That would more commonly be done to determine if there is a need for a prostate biopsy (and can also be done during biopsy to help guide the needle placement). MRI is more often used to check for possible metastasis in people already confirmed to have prostate cancer.

 

I would expect Bumrungrad to also be able to do a prostate MRI if indicated and there is a urologist there who has treated many TV members and is highly recommended  https://www.bumrungrad.com/doctors/Viroj-Chodchoy

 

Unless there is more to the story than you indicated (for example, if you have already had a transurethral ultrsound with results suggestive of cancer, or manual digital exam is indicating an irregular mass), I would recommend first getting another opinion before seeking an MRI.

 

 

[al007]

I was going to say this subject is quite close to my heart, emotionally yes but physically no

 

Over the last 3 months I have had several CT and also MRI scans, for my prostate and colon cancer

 

I am currently undergoing treatment at Chulalongkorn, and believe quality of treatment and equipment is first class

 

I finish my Radiology/chemo next week and the surgeon wants me to have MRI early january, my wife will be booking tomorrow and I will ask her to get the cost, I am expecting it to be lower than your figure

 

Some things show on the MRI that do not show on the CT

 

PM me if you want the cost figs for MRI, I can also give you my phone number, and offer any other help from my experiences on this topic

 

A comment on the prostate biopsy, it can and often does not give a true reading, it is like sticking a needle into an orange 12 times and expecting it to find all bad bits, there is a reasonable chance it can miss, especially if the cancer is localised

 

My prostate surgeon for Holeps told me he found cancer in 40% of cases where the biopsy said none

 

Good luck

Edited November 20, 2016 by al007

[lopburi3]

Expect the MRI at Chula will be similar in cost to some private hospitals - at least that was the case in years past.  Have family member that had severe allergic reaction to contrast and only a passing nurse noticed.

[elektrified]

21 hours ago, Sheryl said:

Bangkok General is the former name of Bangkok Hospital

http://www.bangkokhospital.com/index.php/en

 

It is not to be expected that PSA will decrease with treatment using Alfuzosin as it just provides symptomatic relief by helping to relax the walls of the bladder and urethra, it does not reduce prostate size.  (There are other drugs used in BPH that can, but not alfuzosin and others in its family). As long as the PSA is  under 10 and staying about the  same, or showing only very small and slow increases, this is not in itself a cause for concern.  Rapid increase and levels 10 and over, though, are another story.

 

I am a little surprised at the recommendation for an MRI. Have you already had an transrectal ultrasound? That would more commonly be done to determine if there is a need for a prostate biopsy (and can also be done during biopsy to help guide the needle placement). MRI is more often used to check for possible metastasis in people already confirmed to have prostate cancer.

 

I would expect Bumrungrad to also be able to do a prostate MRI if indicated and there is a urologist there who has treated many TV members and is highly recommended  https://www.bumrungrad.com/doctors/Viroj-Chodchoy

 

Unless there is more to the story than you indicated (for example, if you have already had a transurethral ultrsound with results suggestive of cancer, or manual digital exam is indicating an irregular mass), I would recommend first getting another opinion before seeking an MRI.

 

 

Hi Sheryl, thank you for your reply. Yes, I understand the medicine will not lower my PSA. My PSA goes from 10 to sometimes 11 and even 12 once, then goes back down to 10, then back to 11...etc. I've taken a lot PSA tests these last 3 years (every 3 months).

 

Yes, I had the transrectal ultrasound at the time of my biopsy two years ago now. And as I said, the biopsy was negative and everything looked normal on the ultrasound. I also have the digital rectal exam 2-3 times a year and the doctor says that my prostate, although large, feels normal.

 

The thing is that the doctor has been "gently" pushing me to have another biopsy as he says he is concerned about the PSA. He said that I could have another biopsy and if that the 2nd one is also negative, then the next thing is the MRI. Sensing my reluctance to have another biopsy, he suggested having the MRI.

 

I'm confident in the urologist as he is the best there is Chiang Mai and is considered one of the best in Thailand. But I have read on the forum that he tends to push patients a lot to have surgical and investigative procedures often.

[elektrified]

8 hours ago, al007 said:

I was going to say this subject is quite close to my heart, emotionally yes but physically no

 

Over the last 3 months I have had several CT and also MRI scans, for my prostate and colon cancer

 

I am currently undergoing treatment at Chulalongkorn, and believe quality of treatment and equipment is first class

 

I finish my Radiology/chemo next week and the surgeon wants me to have MRI early january, my wife will be booking tomorrow and I will ask her to get the cost, I am expecting it to be lower than your figure

 

Some things show on the MRI that do not show on the CT

 

PM me if you want the cost figs for MRI, I can also give you my phone number, and offer any other help from my experiences on this topic

 

A comment on the prostate biopsy, it can and often does not give a true reading, it is like sticking a needle into an orange 12 times and expecting it to find all bad bits, there is a reasonable chance it can miss, especially if the cancer is localised

 

My prostate surgeon for Holeps told me he found cancer in 40% of cases where the biopsy said none

 

Good luck

Thank you very much for your comments. If I need to have the MRI then I certainly will seek your assistance. I hope you make an excellent recovery.

[offset]

My first 12 core biopsy was clear of cancer but i was advised by my doctor after taking a FREE PSA blood test that he still felt there was cancer present he advised me to have a 24 core biopsy taken which indeed find cancer, this was 8 years ago so i do not know if treatment as changed since then

[al007]

37 minutes ago, offset said:

My first 12 core biopsy was clear of cancer but i was advised by my doctor after taking a FREE PSA blood test that he still felt there was cancer present he advised me to have a 24 core biopsy taken which indeed find cancer, this was 8 years ago so i do not know if treatment as changed since then

 

Very interesting, backs up what I have heard that the 12 needle biopsy does not necessarily find the cancer even if it is there, hence the 24 needle one

 

So in conclusion if the PSA keeps going up be very wary

 

I am not a doctor but maybe having an MRI as well is a sensible precaution, especially if you have medical insurance

[al007]

2 hours ago, lopburi3 said:

Expect the MRI at Chula will be similar in cost to some private hospitals - at least that was the case in years past.  Have family member that had severe allergic reaction to contrast and only a passing nurse noticed.

 

I comment from my recent experiences only, I may also be incorrect, but I thought the reason they check creatine level by blood test is to see bad reaction does not occur

 

In any case make sure family member with you knows to watch for bad reaction to the contrast, and as the patient shout if you feel bad reaction coming

 

Every time we walk into a hospital we raise the chances of getting an infection

Every time we have MRI, CT, and Xray we take risks but I consider them acceptable, and better the small risk rather than the bigger risk

The prostate biopsy has a level of risk as well

 

I still drive in thailand, although the risk is high, as I say to my wife, I have been lucky on the roads here, but maybe some day my luck will change, and the odds of an accident increase, but I still drive, and cross the road as a pedestrian

[Sheryl]

Contrast reaction can happen regardless of renal function. They check creatnine first but that is because dose of contrast material has to be adjusted if renal function not normal.

 

The reactions are basically an allergic response and while infrequent, can  be life threatening. While people with a history of medication allergies are more at risk, it can happen to anyone. This is why I do not recommend getting an MRI or CT with contrast at a stand-alone imaging center (of which there are some), only a hospital. 

 

PSA in the 10-12 range is indeed high, I can understand why the doctor is concerned.  I can also appreciate your reluctance to undergo another biopsy.

  Are your symptoms well controlled on medication? Because if not, a surgical procedure with biopsy might make more sense than biopsy alone. If it is, then an MRI may make sense as next step before deciding on an additional biopsy. Besides being invasive the problem with biopsy, even 24 core, is that it can miss malignant tissue especially if ultrasound does not indicate a particular location as suspicious.

[al007]

24 minutes ago, Sheryl said:

Contrast reaction can happen regardless of renal function. They check creatnine first but that is because dose of contrast material has to be adjusted if renal function not normal.

 

The reactions are basically an allergic response and while infrequent, can  be life threatening. While people with a history of medication allergies are more at risk, it can happen to anyone. This is why I do not recommend getting an MRI or CT with contrast at a stand-alone imaging center (of which there are some), only a hospital. 

 

 

Thank you Sheryl, again valuable information, also I continue to learn, this sort of information is not given out by the many doctors I see

 

A year ago in KhonKaen my urologist told me of the stand alone facility, as a cost saving measure, he never mentioned the risk factor, and maybe he had never considered it !

 

I blindly went there, and had no plan in the event of a reaction ! ! but then I survived again 

 

I was going to post do not forget the stand alone facilities because they can save substantially on cost,(like 50%) but was not aware of the risks until now

 

I personally have now had far to many MRI's and CT scans, in many places with contrast, and had no reaction, so would guess I am maybe safe so far as the reaction is concerned, India for example is about half of the cost here in Thailand, but then airfares and convenience need to be considered.

 

My wife went to Chula to book MRI for Jan but he lady who does the bookings is out today, it was suggested to my wife the cost for me (Prostate and Rectum) with contrast, would be around 15,000 batt, remember there are many combinations of what is scanned, but depending on who is paying definitely worth checking out

 

Today with the stand alone clinics there is more competion out there which maybe helps bring down costs for the patients

[elektrified]

1 hour ago, Sheryl said:

Contrast reaction can happen regardless of renal function. They check creatnine first but that is because dose of contrast material has to be adjusted if renal function not normal.

 

The reactions are basically an allergic response and while infrequent, can  be life threatening. While people with a history of medication allergies are more at risk, it can happen to anyone. This is why I do not recommend getting an MRI or CT with contrast at a stand-alone imaging center (of which there are some), only a hospital. 

 

PSA in the 10-12 range is indeed high, I can understand why the doctor is concerned.  I can also appreciate your reluctance to undergo another biopsy.

  Are your symptoms well controlled on medication? Because if not, a surgical procedure with biopsy might make more sense than biopsy alone. If it is, then an MRI may make sense as next step before deciding on an additional biopsy. Besides being invasive the problem with biopsy, even 24 core, is that it can miss malignant tissue especially if ultrasound does not indicate a particular location as suspicious.

Yes Sheryl, the medication is quite effective. Sometimes I still have to get up maybe once or twice during the night to urinate, but not every night.

[al007]

MRI PRICE

 

My wife called Chula this morning for MRI booking in January and was told price was 9500 batt, like everything I am told on prices I will believe it when done and paid for, yesterday she was told 15,000, unfortunately being Thai she does not challenge info, like why has it changed so much since yesterday !  !

 

I am told they only do MRI,s on Mondays and Tuesdays, seems a bit amazing to have very expensive equipment so under utilised

 

Having said the above she has a very kind, calm, and loving personality, and I could not have survived my recent ordeals with out her

 

The price is now close to the price of free standing  units, my suggestion is it could be substantially below the price of 20,000 quoted elsewhere in this thread, and worth checking out at Chula

 

I will have the definitive answer in January