PSA test

[bkk6060]

47 minutes ago, Vacuum said:

I've heard/read that the only way to get a sure result regarding prostate cancer, is to do a biopsy (albeit it's like throwing darts blindfolded) So my question is what can they detect with these MRI-scans?

A picture of your prostate to see if it is cancerous, is much better then throwing darts.

Edited June 23, 2018 by bkk6060

[bubba]

16 hours ago, elektrified said:

Any recent experiences on prostate MRI's?

 

I had planned on going to Pitsanuvej to get the 3T MRI but was hesitant based on Dante's experience. I spoke to my doctor the other day about it and he did not seem interested in an MRI from anywhere other than CMU or 3 locations in Bangkok. He said it is more important to have the T-1.5 technology performed by experienced radiology technicians and interpreted by qualified radiologists (like his colleagues at CMU) than new technology interpreted by radiologists he has never heard of before. That makes sense. He didn't even know Pitsanuvej had 3T MRI.

 

I inquired today at both Sriphat and Suan Dok which share the same equipment and same radiologists and technicians. Sriphat is 25,500 Baht and Suan Dok is only 2-3 thousand Baht less but with a 3-4 month queue. I believe that is with contrast dye.

 

I did overhear one technician say that Bangkok C.M. Medical Center offers prostate MRI (T-1.5). Has anyone had a prostate MRI there? If so, how was the experience and what was the cost?

 

Thanks.

 

At the risk of getting a bit lengthy, I do have some experience with prostate MRIs.

 

For several years, I have had significantly fluctuating PSAs. That is, as high as 11 and then back down to 5.2. I was treated a couple of times with antibiotics (a month of Cipro) and PSA would go down some, and then back up and then back down. Another time, Cipro didn't push it down much. My urologist had a gut feeling that this was a case of non-specific prostatitis and didn't think it was a cause to suspect prostate cancer,(PCa) so we just kept watching PSA every three months. After almost two years of that, he referred me for an endorectal coil 1.5T MRI with contrast. The radiologist said no suspect lesions...completely clear with no areas of concern. But...the PSA kept swinging up and down. My urologist still didn't want to do a biopsy, but sort of seemed puzzled and told me to go get a second opinion. I did that at another hospital and this urologist seemed puzzled as well. I do have a large gland, at around 100 cc, and one thing I have learned over literally years of my own research is that a larger gland means you produce more PSA. Being 18 months after the initial MRI, I asked that urologist about whether I should do another MRI and what might that tell us. I was astounded as I sat in his office and he literally went to his PC and started googling prostate MRI and PIRADS scores (more on that later) and he didn't really have an answer. So, cancel that urologist and I decided to take things into my own hands. Through my own research, I learned that 1.5T MRI does not render the resolution necessary to clearly render a small lesion and allow for a reliable PIRADS score. Fortunately, I have an academic background that includes biochemistry, so I was in a slightly better position to understand the literature than some, but admittedly not to the level of a urologist or radiologist. 

 

PIRADS is an acronym for Prostate Imaging and Reporting System. PIRADS has a set of rules that standardises the way a radiologist assesses a lesion that he/she observes in MRI images. The scale runs from 1 to 5, with 1 being very low with clinically significant cancer highly unlikely, to 5 for which clinically significant cancer is highly likely. 

 

I then phoned all the larger hospitals in Bangkok and spoke with techs in their radiology department. I did find a 3T MRI and they could do prostate imaging with contrast, but I did not find their level of expertise to be all that encouraging. As I had a business trip coming up to Honolulu, I decided to enquire there, found a hospital that seemed experienced and competent with 3T MRI for prostate and elected to self-pay for one there at a cost of US$1100. The report came back with a lesion identified by the radiologist as PIRADS 4 – clinically significant cancer is likely to be present. 

 

Now as part of all the reading I have done over the last two years regarding prostate MRI, I have learned:

 

- 1.5T MRI is not currently considered to be adequate for identifying or ruling out lesions with a high degree of confidence.

 

- Even with 3T MRI, some instruments produce superior resolution. Also, the good news is that an endorectal coil is not necessary with the better instruments. What a relief that is.

 

- The skill of the techs in producing the images is very important. In other words, the best MRI with techs that do not know how to use it can result in a marginally useful set of images.

 

- Very importantly, interpreting these contrast images is very complicated and the radiologist may or may not have the skill set and experience to do a superior interpretation. No radiologist is a jack of all trades, the same as a surgeon.

 

So, I was given a PIRADS 4 and nearly any urologist would immediately go to a biopsy. Damn. But....and again from doing a lot of reading, I realised that a second opinion is necessary because I had no idea of that radiologist's expertise in prostate MRIs. I came across the name together with numerous publications and references to a radiologist in the USA who had devoted the last decade of his practice to prostate imaging, and he did second options. He has performed more than 5000 prostate MRIs and just completed his 1000th in-bore MRI biopsy (more on that later as well) I obtained all the imaging data on a CD from the hospital in Honolulu, uploaded it to Dropbox and obtained a second opinion from him. I then had a one hour Skype call with him and he reviewed the images with me as well as the original radiology report in great detail. 

 

His findings:

 

- The instrument used was a superior, high resolution instrument and yielded very good high resolution images. His opinion of 1.5 MRI was that it is not very useful for PCa assessment with a high degree of confidence.

 

- The techs were not great at what they did, but the images they produced were adequate.

 

- And the best part: he revised my PIRADS score to 2. His opinion was that the radiologist had misdiagnosed an area of chronic inflammation as PCa. He said he had commonly seen this and in his words "that radiologist just didn't know what he was looking at". A bit surprising to hear that from one physician being so critical of another physician. He also told me that this had likely been present for years and the 1.5T MRI that I received in Bangkok had completely missed it.

 

- He did not recommend a biopsy at this point and told me he would not even do one for me if I asked him to do so. (I liked that degree of confidence).

 

- But...this sort of chronic inflammation is still cause for concern, since after some time it can result in a malignant lesion, he had seen this happen, and I would have to live with active surveillance for the rest of my life.

 

- His recommendation: continue PSA testing every four months for the next year. If I see each PSA getting higher, get back in for another MRI. If I do not, follow up in one year with another MRI and keep up with the PSAs as an indicator.

 

- My current PSA is 6.5, which he said is completely normal for a prostate of 100 cc, or about twice the average volume for a man of my age. His words: 'nobody should be using a one size fits all PSA to indicate risk, because we must take into account the size of the prostate – a bigger prostate makes more PSA".

 

He referred me to a New England Journal of Medicine publication from March of this year stating that MRIs should be performed before making the decision for a biopsy. This can prevent unnecessary biopsies (which do carry risks as well as over-diagnosis and over-treatment, including unnecessary radical prostatectomies ) and if PCa is detected, the suspicious area is highly localised to better target a biopsy. He also told me that the real gold standard for biopsies now is an in-bore biopsy, where the patient is biopsied while in the MRI tube in order to get a very accurate area for the biopsy. This can mean fewer needles (he sometimes only does 2 - 3 rather than the usual 12 - 18) and knowing where to shoot them means better certainty of actually hitting a PCa lesion. 

 

I have omitted some details including names and hospitals in the above. If I can help you with any ideas or further details, please send me an IM and I would be happy to talk with you about my experiences.

[bubba]

Suggestion to the moderator: Since we are really talking about PSAs, MRI and the associated diagnoses anywhere in Thailand, might it be a good idea to move this from the Chiang Mai local category to the general Health and Medicine category?

[xylophone]

54 minutes ago, bubba said:

At the risk of getting a bit lengthy, I do have some experience with prostate MRIs.

 

For several years, I have had significantly fluctuating PSAs. That is, as high as 11 and then back down to 5.2. I was treated a couple of times with antibiotics (a month of Cipro) and PSA would go down some, and then back up and then back down. Another time, Cipro didn't push it down much. My urologist had a gut feeling that this was a case of non-specific prostatitis and didn't think it was a cause to suspect prostate cancer,(PCa) so we just kept watching PSA every three months. After almost two years of that, he referred me for an endorectal coil 1.5T MRI with contrast. The radiologist said no suspect lesions...completely clear with no areas of concern. But...the PSA kept swinging up and down. My urologist still didn't want to do a biopsy, but sort of seemed puzzled and told me to go get a second opinion. I did that at another hospital and this urologist seemed puzzled as well. I do have a large gland, at around 100 cc, and one thing I have learned over literally years of my own research is that a larger gland means you produce more PSA. Being 18 months after the initial MRI, I asked that urologist about whether I should do another MRI and what might that tell us. I was astounded as I sat in his office and he literally went to his PC and started googling prostate MRI and PIRADS scores (more on that later) and he didn't really have an answer. So, cancel that urologist and I decided to take things into my own hands. Through my own research, I learned that 1.5T MRI does not render the resolution necessary to clearly render a small lesion and allow for a reliable PIRADS score. Fortunately, I have an academic background that includes biochemistry, so I was in a slightly better position to understand the literature than some, but admittedly not to the level of a urologist or radiologist. 

 

PIRADS is an acronym for Prostate Imaging and Reporting System. PIRADS has a set of rules that standardises the way a radiologist assesses a lesion that he/she observes in MRI images. The scale runs from 1 to 5, with 1 being very low with clinically significant cancer highly unlikely, to 5 for which clinically significant cancer is highly likely. 

 

I then phoned all the larger hospitals in Bangkok and spoke with techs in their radiology department. I did find a 3T MRI and they could do prostate imaging with contrast, but I did not find their level of expertise to be all that encouraging. As I had a business trip coming up to Honolulu, I decided to enquire there, found a hospital that seemed experienced and competent with 3T MRI for prostate and elected to self-pay for one there at a cost of US$1100. The report came back with a lesion identified by the radiologist as PIRADS 4 – clinically significant cancer is likely to be present. 

 

Now as part of all the reading I have done over the last two years regarding prostate MRI, I have learned:

 

- 1.5T MRI is not currently considered to be adequate for identifying or ruling out lesions with a high degree of confidence.

 

- Even with 3T MRI, some instruments produce superior resolution. Also, the good news is that an endorectal coil is not necessary with the better instruments. What a relief that is.

 

- The skill of the techs in producing the images is very important. In other words, the best MRI with techs that do not know how to use it can result in a marginally useful set of images.

 

- Very importantly, interpreting these contrast images is very complicated and the radiologist may or may not have the skill set and experience to do a superior interpretation. No radiologist is a jack of all trades, the same as a surgeon.

 

So, I was given a PIRADS 4 and nearly any urologist would immediately go to a biopsy. Damn. But....and again from doing a lot of reading, I realised that a second opinion is necessary because I had no idea of that radiologist's expertise in prostate MRIs. I came across the name together with numerous publications and references to a radiologist in the USA who had devoted the last decade of his practice to prostate imaging, and he did second options. He has performed more than 5000 prostate MRIs and just completed his 1000th in-bore MRI biopsy (more on that later as well) I obtained all the imaging data on a CD from the hospital in Honolulu, uploaded it to Dropbox and obtained a second opinion from him. I then had a one hour Skype call with him and he reviewed the images with me as well as the original radiology report in great detail. 

 

His findings:

 

- The instrument used was a superior, high resolution instrument and yielded very good high resolution images. His opinion of 1.5 MRI was that it is not very useful for PCa assessment with a high degree of confidence.

 

- The techs were not great at what they did, but the images they produced were adequate.

 

- And the best part: he revised my PIRADS score to 2. His opinion was that the radiologist had misdiagnosed an area of chronic inflammation as PCa. He said he had commonly seen this and in his words "that radiologist just didn't know what he was looking at". A bit surprising to hear that from one physician being so critical of another physician. He also told me that this had likely been present for years and the 1.5T MRI that I received in Bangkok had completely missed it.

 

- He did not recommend a biopsy at this point and told me he would not even do one for me if I asked him to do so. (I liked that degree of confidence).

 

- But...this sort of chronic inflammation is still cause for concern, since after some time it can result in a malignant lesion, he had seen this happen, and I would have to live with active surveillance for the rest of my life.

 

- His recommendation: continue PSA testing every four months for the next year. If I see each PSA getting higher, get back in for another MRI. If I do not, follow up in one year with another MRI and keep up with the PSAs as an indicator.

 

- My current PSA is 6.5, which he said is completely normal for a prostate of 100 cc, or about twice the average volume for a man of my age. His words: 'nobody should be using a one size fits all PSA to indicate risk, because we must take into account the size of the prostate – a bigger prostate makes more PSA".

 

He referred me to a New England Journal of Medicine publication from March of this year stating that MRIs should be performed before making the decision for a biopsy. This can prevent unnecessary biopsies (which do carry risks as well as over-diagnosis and over-treatment, including unnecessary radical prostatectomies ) and if PCa is detected, the suspicious area is highly localised to better target a biopsy. He also told me that the real gold standard for biopsies now is an in-bore biopsy, where the patient is biopsied while in the MRI tube in order to get a very accurate area for the biopsy. This can mean fewer needles (he sometimes only does 2 - 3 rather than the usual 12 - 18) and knowing where to shoot them means better certainty of actually hitting a PCa lesion. 

 

I have omitted some details including names and hospitals in the above. If I can help you with any ideas or further details, please send me an IM and I would be happy to talk with you about my experiences.

Excellent post bubba and full of VERY useful info, and I will be keeping a copy of this on my files!!

 

I would like to add something, especially for those of us who have suffered from long-term prostatitis, because I have, for over a couple of decades unfortunately.

 

Those of us that have had this condition know how it can really affect your quality of life, with aching testes, back pain, pain in the perineum and the occasional burning of the urethra. Despite all of this and every test that was done, no bacteria could be isolated, so it was determined that I had nonbacterial prostatitis.

 

Having said that, time and time again when I went back to a urologist, or three of them in all, I was given different antibiotics, this mainly because one antibiotic in particular really did relieve all of the symptoms (doxycycline, 1 x 100 mg tablet a day) so my question to the urologist was if it is not bacterial, then why am I having antibiotics, and why does this particular one work.

 

Not one was able to give me a definitive answer although my own doctor (also a surgeon and very experienced) suggested that doxycycline has also been shown to have a small anti-inflammatory effect, and because it also penetrates the prostate probably better than other antibiotics, then it could be why that was happening.

 

I was on doxycycline for three months at a time and when all of the symptoms disappeared, it would be about two or three months before they came back again, so I repeated the whole cycle, this probably over almost 2 decades, as I said.

 

During that time I never had an adverse reading on my PSA, so further prostate screening didn't come into it.

 

I also did a lot of reading on prostatitis and antibiotics which may or may not work, and one thing that kept coming back in some of the more in-depth research was the effect of "a biofilm" that was possibly preventing the antibiotics from fully getting at the bacteria (the biofilm seems to hide them somehow) and killing them off, allowing them to "re-emerge" again later on, which was what was happening in my case.

 

One urologist told me that he had patients who had been on doxycycline for many, many years and that was the only way they could get relief from their prostatitis – – – as one urologist and researcher who specialised in this area said, "this area is a medical wasteland".

 

I'm not sure if taking something like this would help with the PSA reading, however it certainly seemed to help with my prostatitis. For what it's worth.

 

[bubba]

That's interesting, Xylophone. I have read that many antibiotics also have a mild anti-inflammatory effect, and our lowering of PSA levels following treatment may indeed be the result of that rather than an antibiotic effect. 

 

Have you ever had a culture done of prostatic fluid? I have had three: in two of them, they did culture bacteria (different in each case). If they do culture bacteria, the doc can better target the pathogen by selecting the best antibiotic against it. 

 

The radiologist I referred to told me that at least in my case of prostatitis, he felt there was no way we would ever find the root cause and I would just have to live with it. That is sort of like your "medical wasteland" comment. It is interesting that you have never had elevated PSA, as in most cases of prostatitis as clinically significant as yours, elevated PSA is almost always a result.

 

Have you considered curcumin? There have been many anectdotal accounts of that providing some relief, presumably due to its anti-inflammatory properties. There have also been some studies showing that COX-2 inhibitors (which are anti-inflammatories) such as Celebrex and Arcoxia can provide some relief for prostatitis. You may want to ask your urologist about that. These are available over the counter in Thailand, but there are certain predisposing health considerations to be considered before prescribing them, so I think consultation with a physician would be a good idea before you try self-medicating with those. 

 

COX-2 has also been shown to play a role in PCa. You can learn more with some googling.

[xylophone]

2 minutes ago, bubba said:

That's interesting, Xylophone. I have read that many antibiotics also have a mild anti-inflammatory effect, and our lowering of PSA levels following treatment may indeed be the result of that rather than an antibiotic effect. 

 

Have you ever had a culture done of prostatic fluid? I have had three: in two of them, they did culture bacteria (different in each case). If they do culture bacteria, the doc can better target the pathogen by selecting the best antibiotic against it. 

 

The radiologist I referred to told me that at least in my case of prostatitis, he felt there was no way we would ever find the root cause and I would just have to live with it. That is sort of like your "medical wasteland" comment. It is interesting that you have never had elevated PSA, as in most cases of prostatitis as clinically significant as yours, elevated PSA is almost always a result.

 

Have you considered curcumin? There have been many anectdotal accounts of that providing some relief, presumably due to its anti-inflammatory properties. There have also been some studies showing that COX-2 inhibitors (which are anti-inflammatories) such as Celebrex and Arcoxia can provide some relief for prostatitis. You may want to ask your urologist about that. These are available over the counter in Thailand, but there are certain predisposing health considerations to be considered before prescribing them, so I think consultation with a physician would be a good idea before you try self-medicating with those. 

 

COX-2 has also been shown to play a role in PCa. You can learn more with some googling.

Thanks again bubba, and yes I did have tests done on my prostatic fluid, on quite a few occasions, but nothing showed up, so nothing could be cultured I'm afraid (or at least that's what the urologist said).

 

My urologist said about the same with my prostatitis, inasmuch as we may never find out what causes it – not the sort of news one wants to hear when one is suffering from it's effects!

 

I did try curcumin for a while but it didn't seem to make any difference.

 

And yes, I did some research on the Cox-2 inhibitors and whenever it got really bad, Celebrex taken over just a few days certainly helped get past the bad times. Luckily I have a healthy heart so I'm not unduly worried about karking it after taking a couple of tablets.

 

Now here's something which may well be a pointer...........after having a minor urological operation here, I contracted E. coli ESBL  (hospital-acquired) which as you know is just about resistant to all antibiotics, so I had to go on a 14 day regimen of intravenous carbapenem, a very powerful but little used antibiotic, and after this all symptoms of the prostatitis seem to have completely disappeared!

 

Make of it what you will, but the moment I'm free of the symptoms and if I do get the usual aches with it, then a couple of Celebrex or even Cataflam seem to do the trick.

 

Cheers and good to share experiences with you and I hope others following this thread will have gleaned some useful knowledge from it.

[bkk6060]

I have had big fluctuations in my PSA.

I am no expert.  My father had P cancer so I always get it checked.

 

I believe these things affect the test up or down:

 

Sitting for long periods

Being hydrated/dehydrated

Sexual activity

Alcohol

Rest

 

I am sure you can figure it out.  

I am currently at 1,7.  Have been over 5.

No drinking, lots of walking, some boom boom, lots of water and sleep early, I get a lower test result.

 

Just saying.  I am sure everyone is different.

 

 

 

 

[xylophone]

17 minutes ago, bkk6060 said:

I have had big fluctuations in my PSA.

I am no expert.  My father had P cancer so I always get it checked.

 

I believe these things affect the test up or down:

 

Sitting for long periods

Being hydrated/dehydrated

Sexual activity

Alcohol

Rest

 

I am sure you can figure it out.  

I am currently at 1,7.  Have been over 5.

No drinking, lots of walking, some boom boom, lots of water and sleep early, I get a lower test result.

 

Just saying.  I am sure everyone is different.

 

 

 

 

A friend who has frequently high PSA readings said that his specialist in Oz suggested he didn't have sex for a day or so (can't remember exactly now!!) prior to the tests as it could result in higher PSA readings.

[bkk6060]

7 minutes ago, xylophone said:

A friend who has frequently high PSA readings said that his specialist in Oz suggested he didn't have sex for a day or so (can't remember exactly now!!) prior to the tests as it could result in higher PSA readings.

It seems to be some lack of education generally.

I hope most guys know what the Prostate gland is there for.

It is a gland whose muscles propel the seminal fluid into the urethra, during ejaculation.

So, it is sexually functioned based.

I am not sure at this point if too much or too little sex affects the PSA.

I personally have a lot of sex.

But, if I take a few days off before my test, the PSA seems to be lower.

Just my report on this.

 

 

[bubba]

@bkk6060: I know of another one to add to the list: bicycle riding. I have a friend who showed a PSA of 7.5. He is an avid cyclist (62 years old), riding distances every day. His doctor told him to get off the bike for a month and come back for another PSA. That one was 4.5. He has since installed a special seat for prostate issues and will go back in another three months for another one. That was a dramatic decrease in just one month and his urologist is sure it was the cycling.

 

@xylophone: the general guidance for abstinence is to abstain for 48 hours before your PSA draw. I was even given printed instructions that specified that at one hospital. However, from what I have read, that really might only increase the PSA by a few tenths.

 

I might add that my prostate radiologist specialist advised me to "keep the pipes clean" as he said by keeping hydrated and also with...ahem...ejaculations as frequently as you might feel inclined to have. If that is not enough, then he advised engaging an able assistant if one does have one. No really, that is what he said. He then went on to cite some studies where frequency of ejaculation (or the lack thereof) can relate to PCa occurrence and inflammation. 

 

I believe BKK6060 mentioned that the above is part of his prostate health regimen. 

 

 

[hmficc]

On 5/10/2017 at 4:39 AM, xylophone said:

Not so sure about your statement above, because I suffered from BPH and prostatitis for some 20 years and my PSA score was always below one!! And my prostate has always been small, and still is,  so the correlation between BPH and prostate size just doesn't add up for me.

 

In addition, others have mentioned about PSA levels and what should be done about them, however it's important to note that taken as an individual score, it means not a lot at all – – it has to be viewed in light of any inflammation or any infection of the urinary tract, the size of the prostate when measured by a DRE, any pain or noticeable growth in size of the prostate and any quick rise in PSA scores.

 

Sexual activity just prior to a PSA test can mean that it elevates slightly and as I said above, inflammation or infection of the prostate will also lead to a higher PSA score.

 

Just yesterday I had a PSA test done and for as long as I can remember my score was under one, however yesterday it was just under 10. Cause for alarm you may well think, but I have a UTI due to catheter use and in my opinion and that of the specialist I saw, that will certainly increase the PSA score, so keeping an eye on how that score progresses over the course of some antibiotics I am on is important.

 

Follow-up appointment scheduled in one weeks time however I would think that my best bet would be to get another PSA test done in about two weeks to a month.

 

Small prostate and BPH=one can not predict the size of a donut’s hole by the size of the donut.

 

[RxDan]

Having been in the medical profession for 30 years I can offer some input involving prostate.  PSA is a relative number and sometimes causes a false positive test, therefore a digital exam and MRI will definitely corroborate cancer etc. Also if getting a preliminary Ultrasoind should get at least 2 or 3 to compare as the results are only as good as the operator.  I have had prostatitis for over 30 years which come and goes , with always a normal PSA and digital exam. Floroquinolones like Cipro has been the mainstay but recent studies of heart arrthymias have changed the regimen to NORFLOXACIN..They have been used with infectious prostatitis but also non infectious prostatitis which I have always had. Also the screening to have changed to a younger age not older.

[elektrified]

14 hours ago, xylophone said:

A friend who has frequently high PSA readings said that his specialist in Oz suggested he didn't have sex for a day or so (can't remember exactly now!!) prior to the tests as it could result in higher PSA readings.

That is for "Free PSA" test. Doesn't matter for "Total PSA" test. For "Free PSA" tests, no sex or riding a bicycle for 48 hours.

[bubba]

1 minute ago, elektrified said:

That is for "Free PSA" test. Doesn't matter for "Total PSA" test. For "Free PSA" tests, no sex or riding a bicycle for 48 hours.

I believe you will find that the recommendation is for total PSA. Free PSA (e.g. not bound to serum proteins) is a component of total PSA and it all comes from the same place for the same reasons. 

[elektrified]

16 hours ago, bubba said:

At the risk of getting a bit lengthy, I do have some experience with prostate MRIs.........<snip>

 

 

 

This is an excellent post bubba! In my case I have already had a biopsy about 4 years ago which was negative. But I continue to have rising PSA levels which is why further investigation is required. Yes, I agree that the MRI T-3 is the best, but in Chiang Mai it is not available. My doctor has ordered the new Tesla 3 machine for C.M. University Hospital but he said that it won't be until sometime next year that it is here and up and running. So that presents a problem. The only place that has the T-3 technology within a reasonable distance is in Pitsanulok and there seem to be some issues there. I have checked into having it done at Siriraj and Chulalongkorn, but it is very difficult if you don't live in Bangkok since a few visits are required; each a couple of weeks apart.  That is why the doctor recommends going with the T-1.5 MRI with contrast here at CMU, because the radiology department is very experienced in doing prostate MRI's (the same "crew" has been there for years) and the radiologists that interpret them have done many, many and the doctor knows them from the University (some are Professors like him) and he trusts their interpretation of the scans. He said (as did you), that the newest and best technology being administered by inexperienced technicians and interpreted by radiologists new to T3 technology would be worse than the older T-1.5 being done by people with years of experience. If I had a way to stay in Bangkok for a few weeks to back and forth to the large government institutions I would, but I don't.

[tideout]

RE: elektrified/bubba and everyone else.

Thanks so much for the informative posts. Really appreciated. I'm going in later for results on a first PSA and pretty worried. I'm thinking if it's a bad score then I might head to BKK to try a a T-3 level look. I'm in Vietnam and concerned given some recent (and I guess ongoing) stories here about competence in diagnosing things. It's not the doctor or the machine but the folks reading/interpreting things. A T-3 screen would take several weeks to get done in BKK? I'd likely be able to get a DVD image there to consult with someone from home (US)?

Again, thanks for any thoughts.

[bubba]

Tideout: From my experience and having discussed all this with a radiologist who only does prostate MRIs, his opinion regarding usefulness of an MRI was:

 

1. Only 3T MRIs are very useful and even then, some instruments are better than others.

 

2. The competence and experience of the MRI facility and the techs is important. A great instrument with techs who do not conduct the scan properly can yield images that are not useful. 

 

3. As you said, the experience and competence of the radiologist in interpreting multi parametric MRIs (with contrast) is essential. I learned that from getting a second opinion that saved me from what he thought would be an unnecessary biopsy. Also, the gadolinium contrast is essential.

 

If you do find a good 3T prostate MRU facility in Bangkok (I couldn't) and have the images done, you can message me here for the contact information of the radiologist in the USA that did my second opinion. You can upload the images from your DVD to Dropbox and his staff will download them for his review.

 

Good luck and hopefully that PSA comes out low!

[tideout]

14 hours ago, bubba said:

Tideout: From my experience and having discussed all this with a radiologist who only does prostate MRIs, his opinion regarding usefulness of an MRI was:

 

1. Only 3T MRIs are very useful and even then, some instruments are better than others.

 

2. The competence and experience of the MRI facility and the techs is important. A great instrument with techs who do not conduct the scan properly can yield images that are not useful. 

 

3. As you said, the experience and competence of the radiologist in interpreting multi parametric MRIs (with contrast) is essential. I learned that from getting a second opinion that saved me from what he thought would be an unnecessary biopsy. Also, the gadolinium contrast is essential.

 

If you do find a good 3T prostate MRU facility in Bangkok (I couldn't) and have the images done, you can message me here for the contact information of the radiologist in the USA that did my second opinion. You can upload the images from your DVD to Dropbox and his staff will download them for his review.

 

Good luck and hopefully that PSA comes out low!

My PSA just got back and it's .229. I guess I'm insane sometimes. I'm 58 but will now make it a point to keep an eye on it thanks to people who've shared in the forum.

I seriously want to thank everyone for all of their posts and responses, especially bubba's willingness to share his well written and researched thoughts on it. I will not be looking at this issue the same from here on out - I know this is just one reading at one time......the internet isn't always a great spot for dialogue these days but my hat's off to everyone in this discussion. I'll keep an eye on things here and in the body.....hopefully I'll meet some of you some day!

[xylophone]

1 hour ago, tideout said:

My PSA just got back and it's .229.

Fantastic result, well done and stop worrying for a while...….I'll raise a glass or two for you tonight!

[bubba]

Great news, timeout!

 

At 58 yo can't even get much lower than that and still have a prostate. I'm seconding xylophone and hoisting a few for you tonight as well. 

[tideout]

Back at you guys. Here's another one to everyone on the board here !?

[GarryP]

Results just back from my PSA test. 0.59 so happy with that. How frequently should I be having these tests. This was my first at near as damn it 56 years old? Annually or bi-annually? 

[bubba]

I think you should be happy, Garry. For 56 years old, a 0.59 is definitely at the low end or normal. I don't think any urologist would suggest that you do a PSA bi-annually. Some would suggest that you don't do any at all. Others would suggest an annual PSA to watch PSA velocity. PSA almost always increases with age and inevitable growth of the gland, so what they would look for over time is how fast PSA is increasing and doubling time. That said, there is a small percentage of men with normal or low normal PSA who actually have high grade adenomas, so PSA is not always definitive. 

 

[JimmyJ]

I couldn't find any news confirming that the US medical profession are now again recommending PSA testing, as someone stated early in this thread.

 

I did find this:

 

"Why I Won't Get a PSA Test for Prostate Cancer"

 

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

 

I also will not get a PSA test.

And haven't for the past 11 years.

 

 

Edited November 20, 2018 by JimmyJ

[Dumbastheycome]

On 5/9/2017 at 3:14 PM, NancyL said:

Your friend had benign prostatic hyperplasia.  According to Dr. Wiki about 50% of men some evidence of it by age 50 and 75% by age 80.  It is correlated with the use of alcohol and caffeine and some studies suggest it's also correlated with consumption of high amounts of protein.  It's really a very common condition in older men who live a western lifestyle.

 

https://en.wikipedia.org/wiki/Benign_prostatic_hyperplasia

 

 

 

Quite relevant. My nominal PSA is  6.1 but  dammed if I will  stop  drinking  tasty wine, tender beef steak, wake up  expresso and Indo kretek. lol

[JimmyJ]

24 minutes ago, JimmyJ said:

I couldn't find any news confirming that the US medical profession are now again recommending PSA testing, as someone stated early in this thread.

 

I did find this:

 

"Why I Won't Get a PSA Test for Prostate Cancer"

 

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

 

I also will not get a PSA test.

And haven't for the past 11 years.

 

 

 

Followup article:

 

"Why We Overrate the Lifesaving Power of Cancer Tests"

 

"Science journalist Gary Taubes weighs in on PSA tests and mammograms"

 

https://blogs.scientificamerican.com/cross-check/why-we-overrate-the-lifesaving-power-of-cancer-tests/

 

`

[bubba]

10 minutes ago, JimmyJ said:

I couldn't find any news confirming that the US medical profession are now again recommending PSA testing.

 

I did find this:

 

"Why I Won't Get a PSA Test for Prostate Cancer"

 

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

 

I also will not get a PSA test.

 

 

I believe the issue with that opinion article is this:

 

PSA can indeed be indicative of PCa, but not definitive unless it is very high. A high PSA without consideration for gland size and PSA density can indeed lead to misdiagnosis, unnecessary biopsies and over-diagnosis. What the article did not mention was the recent recognition of multiparametric MRI in differential diagnosis before recommending a biopsy. For example, the article mentions inflammation as a possible cause for elevated PSA. MRI with interpretation by a radiologist experienced with prostate imaging can differentiate between a PCa lesion and inflammation. It is also important to recognise chronic inflammation since that can later lead to PCa, so active surveillance is necessary. Personally, that is where I am at the moment - elevated PSA, large gland with low PSA density, MRI diagnosis of chronic inflammation, with the recommendation for frequent PSAs to watch for a significant increase in PSA velocity and annual MRIs. Without the MRI and my PSA > 7 and sometimes as high as 11, many urologists would have immediately recommended a biopsy. MRI results contravened that.

 

All that said, if men never have a PSA with no record of PSA velocity, there is no way that PCa can be diagnosed in time for treatment since in many cases there are no symptoms at all, even up to the point of extracapsular tumour growth and metastasis. 

[JimmyJ]

2 minutes ago, bubba said:

I believe the issue with that opinion article is this:

 

PSA can indeed be indicative of PCa, but not definitive unless it is very high. A high PSA without consideration for gland size and PSA density can indeed lead to misdiagnosis, unnecessary biopsies and over-diagnosis. What the article did not mention was the recent recognition of multiparametric MRI in differential diagnosis before recommending a biopsy. For example, the article mentions inflammation as a possible cause for elevated PSA. MRI with interpretation by a radiologist experienced with prostate imaging can differentiate between a PCa lesion and inflammation. It is also important to recognise chronic inflammation since that can later lead to PCa, so active surveillance is necessary. Personally, that is where I am at the moment - elevated PSA, large gland with low PSA density, MRI diagnosis of chronic inflammation, with the recommendation for frequent PSAs to watch for a significant increase in PSA velocity and annual MRIs. Without the MRI and my PSA > 7 and sometimes as high as 11, many urologists would have immediately recommended a biopsy. MRI results contravened that.

 

All that said, if men never have a PSA with no record of PSA velocity, there is no way that PCa can be diagnosed in time for treatment since in many cases there are no symptoms at all, even up to the point of extracapsular tumour growth and metastasis. 

 

"All that said, if men never have a PSA with no record of PSA velocity, there is no way that PCa can be diagnosed in time for treatment since in many cases there are no symptoms at all, even up to the point of extracapsular tumour growth and metastasis."

 

The followup article I posted makes some interesting points.

 

In my case, I haven't read of any treatments I am willing to undergo, so it is pointless and counterproductive for me to get the test.

 

 

[JimmyJ]

Thanks to thaibeachlovers for having the courage to  make his brutally frank posts about some major issues rarely discussed.

 

[bubba]

17 minutes ago, JimmyJ said:

 

"All that said, if men never have a PSA with no record of PSA velocity, there is no way that PCa can be diagnosed in time for treatment since in many cases there are no symptoms at all, even up to the point of extracapsular tumour growth and metastasis."

 

The followup article I posted makes some interesting points.

 

In my case, I haven't read of any treatments I am willing to undergo, so it is pointless and counterproductive for me to get the test.

 

 

I suppose that depends on how old you are, what sort of treatments can be considered and whether you consider those to be less desirable to an early, unnecessary and painful death due to metastatic prostate cancer. When PCa is detected early, there are emerging treatments such as focal laser ablation that will spare you from a radical prostatectomy and the potentially associated issues as well as saving your life.