How to avoid a biopsy to test for prostate cancer

[al007]

1 hour ago, chopin2 said:

the report is only as good as the eyes and knowledge interpreting the MRI and CT scans

 

Same goes for a biopsy. The eyes and knowledge of the pathologist.

This is all so true, but we can improve things by being vigilant, and questioning, something not really liked in this country, The doctors are important and valuable BUT not Gods

 

Some of this goes back to schooling here when pupils are taught not to qustion the teacher

 

It is further not helped by the fact as it is seen as loosing face to say I do not know

 

I believe if we can understand all this we have a better chance of not being misdiagnosed

 

I will also add I have met and seen some exceedingly well qualified doctors here, another problem they are also overworked

 

We all make mistakes, and those who say otherwise are only kidding themselves

[al007]

I am doing something a little unauthodox by replying to a private message in open forum, that I received a few moments ago, I have been very careful to see it remains anonymous, I do this because I believe we can all learn from this, and trust the sender of the message is not upset at me

 

I hope it all goes well for you

For the last few years My wife and I have had our 'annual' checks at Princhess Chulabhorn research Centre where you have been recently. This year we both had the 'tummy' Ultrasounds as they were on offer and it was suggested afterwards that I have an MRI (or another Ultrasound in 3 monthstime ... I went for the MRI and fortunately it was okay. I though both the ultrasound and MRI were very thorough .. both times the 'boss' was asked to have a looksee.

My PSA is fine at about 1.5/1.6 for a few years now, but I have quite a big Prostrate. Earlier in the year I had a 'look up' and a 'look down' at the same time.  That is my 2nd look up ... had one 5 years previous.

I'm interested in  your comment 'choose you doctor carefully' there.  How did you choose the Dr there please, and who?

FYI the are expanding and I have very recently also had a heart ultrasound and a treadmill straight after... cheap at about 2500thb!.

 

As I have said elsewhere I am very happy on my treatment at Chulalongthorn

 

I wound up there because Sheryl told me to go and see Dr Chucheep at his clinic at Bangkok Christian hospital, (at that time I was at my wits end and pretty desperate and very depressed, I received a lot of private message help) and I was lucky he saw me, and referrerd me to his radiologist Dr Chackapong, who I also saw at BCH, but then told me he wanted to do the radiotherapy at Chula, I also now see Dr Chuchcheep( who also does surgery at the Bumrungrad) at Chula

 

My treatment started at once at Chula, I could have had treatment at Khonkaen government hospital but was going to have to wait for a month and on far older less sophisticated equipment, with hindsight I am so happy I made the effort and went to Bangkok for the seven weeks of treatment

 

I believe Dr Chucheep, is one of the two top colorectal surgeons in Thailand, I have also seen his friend another top colorectal surgeon Dr Art Hiranyakas from Bangkok hospital in Phuket, for a second opinion, this man was recommended by another TV member

 

I believe I am getting the highest quality care and attention at government prices and very reasonable affordable cost

 

I am having another colonoscopy with Dr Chucheep late February, at Chula re the colon/rectum cancer, to see what the next move is

 

Yes Chula is building a state of the art new radiation centre, the place is just a building site at the moment

 

When at Chula recently and having food in their canteen, incidentally very nice and good quality food at penny prices; I got talking to the Sales Manager of Varian from Hongkong, who will being installing the new equipment, ( very high tech nuclear and millions or billions of batt) this is a joint venture with the UK and USA on manufacture, this man also told me Chulas existing Varian radiation technology is the best in Thailand, which I found very comforting

 

At the moment I am leaving the prostate alone, I am advised the radiation and chemo worked well there, it is not the urgent one

 

My philosophy of choose the doctor carefully,  comes from listening to Sheryl and others on TV

 

Again writing here concentrates my mind and when I next see Dr Chucheep I will ask him to refer me to a urologist for him to re evaluate my prostate situation at present my PSA is 0.75 down from 15.5

 

I also had Holep surgery in India for the prostate as I was getting up too much in the night to pee, and another TV member is also going to my surgeon there

 

I may sound a hyperchrondriac because of all my hospital stuff but until six months ago I only went for annual check ups probably every 18 months, and was on no medication, I never though I would get cancer yet alone two !!

 

I consider myself a very lucky man ! and have to say thank you  God

 

 

[ballzafire]

From Dr. Mercola's site:

 

http://search.mercola.com/results.aspx?q=psa prostate biopsy

 

Quote from first article in above list :

 

 

Quote

 

... Prostate Biopsies Can Result in Dangerous Infections

A positive PSA test will typically lead to a biopsy—which has also come under increasing scrutiny and criticism in recent years. On the one hand, the procedure itself may cause acute or long-term harm, and on the other, the rate of false negatives is high.

There are over one million prostate cancer tissue biopsy procedures performed annually in the U.S. Approximately 25 percent of these tissue biopsies are reported "positive," indicating the presence of prostate cancer. The remaining 75 percent are reported "negative." One-third of the men with initial "negative" results for prostate cancer actually do have prostate cancer that was missed by the biopsy.

A prostate biopsy involves inserting fine needles into the prostate gland. But specialists have begun to worry about a recent, significant increase in the risk of complications from the procedure. In particular, they are concerned about hard-to-treat bloodstream infections that can require weeks of treatment. Over the past decade, the rate of hospital admissions in Ontario, Canada, for serious infections caused by prostate biopsy increased four-fold.

Earlier this summer, the NPR reported:

"Doctors all over the world are increasingly concerned about post-biopsy infections. At last week's annual meeting of the American Urological Association, there were 10 reports on the phenomenon ... The underlying problem, many say, is the spread of antibiotic-resistant microbes."

Prostate biopsies inherently pose a risk for infection because:

 

• The needles that collect a tiny piece of prostate tissue can transport bacteria through your rectal wall into the prostate and bloodstream, and/or
• The needles can spread harmful bacteria present in your gut into your bloodstream

 

...

 

 

May I suggest everyone concerned read at least this first article in its entirety, so you can become better informed.  I trust Dr. Mercola's advice.  His information has helped me tremendously.

 

Edited January 29, 2017 by ballzafire

[ballzafire]

For the record, from my previous post, regarding incidence of infection from prostate biopsies, change "high" to the more correct "recent, significant increase..."

[al007]

8 hours ago, ballzafire said:

For the record, from my previous post, regarding incidence of infection from prostate biopsies, change "high" to the more correct "recent, significant increase..."

I would not dispute what you might be saying, but we , well not actually we but I need to keep it in context

 

Let us agree living is terminal. only question is when!!

 

Living in Thailand and driving here can definitely be life threatening and very dangerous

 

I know people who will not drive cars here for this reason but they drive motor bikes, my view madness but their right!

 

I drive but with great vigilance, and normally my wife watching for the idiots as well, she also has a rear view mirror

 

I do not know the answer, and can not advise others what to do, except read what you can and make a decision evaluating the risk factors and comfort levels

 

Would I have had a biopsy with what I originally knew, probably no, and I did not, but an incorrect decision because I was not well enough informed

 

I have to refer everyone to Sheryl's comment earlier in this thread 

 

The decision to biopsy or not; is complex.

 

 

[geriatrickid]

On 1/19/2017 at 9:00 PM, soalbundy said:

This was in an English newspaper today stating that an MRI scan could replace biopsies, which can also cause problems themselves. What did the scan cost? 

NO. No. No.

You are taking the report out of context. It is derived from REPEAT cases, where there is suspicion of cancer in those who have already had a biopsy.

 

The MRI isn't a replacement for a biopsy. Rather it is a tool. The UK study isn't anything not already known. The American Urology Association's cost benefit analysis, has been public for 2 years. Note the 2016 statement recommending MRIs when there was a previous biopsy.

 

PROSTATE MRI AND MRI-TARGETED BIOPSY IN PATIENTS WITH PRIOR NEGATIVE BIOPSY Collaborative Initiative of the American Urological Association and the Society of Abdominal Radiology’s Prostate Cancer Disease-Focused Panel

 

The MRI was first recommended when there was an initial negative biopsy,  prostate MRI and subsequent MRI-targeted cores appear to facilitate the detection of  disease compared to a standard repeat biopsy. It is recommended that when high-quality prostate MRI is available, it sbe employed for a patient with a prior negative biopsy who has persistent clinical suspicion for prostate cancer. ·There is a condition; The decision whether to perform MRI must take into account results of any other biomarkers, the cost of the examination, as well as availability of high quality prostate MRI interpretation. ·This is the big deciding factor. There are not enough diagnostic radiologists with the skills to diagnose, nor is there enough equipment  to carry out the recommendation. It is expensive. The health care system cannot afford to pay for all the MRIs which will most likely require biopsies as well.

 

The common practice is to avoid a biopsy if the biological markers are not there and there is no evidence of growth.

 

In respect to a cost benefit analysis, here  is the American Urology Association findings;

Cost of Prostate MRI-US Fusion– A Decision Analysis comparing cost effectiveness of Systematic Transrectal Ultrasound Guided Biopsy and MRI-Ultrasound Fusion Prostate Biopsy in the Initial and Repeat Biopsy Setting.

Over 1 million transrectal ultrasound (TRUS) guided prostate biopsies are performed annually in the United States. However, systematic TRUS biopsy has poor sensitivity and miss clinically significant cancers. Initial reports of MRI-US fusion have demonstrated improved cancer detection rates and accuracy.

In the scenario of an initial biopsy setting, a standard systematic TRUS biopsy was found to be more cost effective at $1,502/QALY compared to $1,698/QALY for MRI-US fusion biopsy. However, in the setting of a repeat biopsy after a prior negative pathology result, the MRI-US fusion biopsy was found to be more cost effective ($2,133/QALY) when compared to a standard repeat systematic TRUS at $2,208/QALY.

Conclusions
Prostate MR imaging with MRI-US fusion provides a more cost-effective strategy compared to traditional systematic TRUS biopsy in the setting of persistent clinical suspicion after a prior negative biopsy. However, in the setting of initial diagnosis, standard systematic TRUS is estimated to be more cost-effective than strategies which employ prostate MRI. It is important to recognize that our findings are limited by our assumptions and parameters of diagnostic test characteristics.

 

 

[siam2007]

11 hours ago, al007 said:

I am doing something a little unauthodox by replying to a private message in open forum, that I received a few moments ago, I have been very careful to see it remains anonymous, I do this because I believe we can all learn from this, and trust the sender of the message is not upset at me

 

I hope it all goes well for you

For the last few years My wife and I have had our 'annual' checks at Princhess Chulabhorn research Centre where you have been recently. This year we both had the 'tummy' Ultrasounds as they were on offer and it was suggested afterwards that I have an MRI (or another Ultrasound in 3 monthstime ... I went for the MRI and fortunately it was okay. I though both the ultrasound and MRI were very thorough .. both times the 'boss' was asked to have a looksee.

My PSA is fine at about 1.5/1.6 for a few years now, but I have quite a big Prostrate. Earlier in the year I had a 'look up' and a 'look down' at the same time.  That is my 2nd look up ... had one 5 years previous.

I'm interested in  your comment 'choose you doctor carefully' there.  How did you choose the Dr there please, and who?

FYI the are expanding and I have very recently also had a heart ultrasound and a treadmill straight after... cheap at about 2500thb!.

 

As I have said elsewhere I am very happy on my treatment at Chulalongthorn

 

I wound up there because Sheryl told me to go and see Dr Chucheep at his clinic at Bangkok Christian hospital, (at that time I was at my wits end and pretty desperate and very depressed, I received a lot of private message help) and I was lucky he saw me, and referrerd me to his radiologist Dr Chackapong, who I also saw at BCH, but then told me he wanted to do the radiotherapy at Chula, I also now see Dr Chuchcheep( who also does surgery at the Bumrungrad) at Chula

 

My treatment started at once at Chula, I could have had treatment at Khonkaen government hospital but was going to have to wait for a month and on far older less sophisticated equipment, with hindsight I am so happy I made the effort and went to Bangkok for the seven weeks of treatment

 

 

 

 

Will you have to bring a native Thai speaker to go to Chula ? My Thai certainly is not good enough to discuss medical topics with medical staff that can not speak English

[Sheryl]

The doctors will usually speak English well (definitely will if you choose the right ones).

 

The nurses, clerks etc will not and it helps to have a Thai speaker with you the first time to help navigate the bureaucracy,

[al007]

3 hours ago, Sheryl said:

The doctors will usually speak English well (definitely will if you choose the right ones).

 

The nurses, clerks etc will not and it helps to have a Thai speaker with you the first time to help navigate the bureaucracy,

The registration process without a Thai speaker, is testing, and difficult, but once past this stage all my doctors speak good english, and most have worked outside Thailand, many of the nurses speak good english

 

You need patience, and often I have little, also bear in mind the hospital is a government run, I have sometimes been very frustrated at having to wait up to four hours for an appointment

 

I can promise you however the cost savings are exceedingly very substantial, and if money important to you as it is to me VERY VERY much worth waiting and the patience required, to receive the highest quality medical care

 

Everything comes at a price, I believe healthcare this way is substantially  subsidised  by the Thai government and I say a very big thank you

 

You can also go to a big hospital here , no wait, guaranteed very big bill and bad medical advice and care

 

I was at one expensive hospital and having a crown done, I was gagging a lot, I told the dentist if he lift my head a little I will be Ok, he said but I have to stand, and can not sit, I replied my father a very eminent dental surgeon and he stand all his life, (ALSO WEARING LONG WHITE COAT THAT HE CHANGED FOR EACH PATIENT)

 

This dentist then gets mad at me and says he will stop and refund my money, , when I nearly passed out gagging, I do not die quietly !!

 

I reply you are half way through this procedure and threatening me with stopping

 

Eventually he finish. and the tries to charge me 30% more than the written estimate

 

I leave and request the general manager, well actually demand,in reception rather forciblay when they try to get me to leave, with a promise they will investigate,

 

I ask the hospital general manager, if your hospital half way through open heart surgery, and a small problem do you stop and offer a refund, do I need to advise my friends accordingly

 

needless to say my bill was adjusted to the original estimate and that dentist has been let go

 

Moral just because you are paying high price guarantees nothing

 

I do not praise easily but so far Chula wonderful for me, I still have to help them with comments like my india prostate surgeon wonders why you have not put me on hormone therapy, I am now on hormone therapy ! !

Edited January 30, 2017 by Sheryl
offensive phrase removed

[lopburi3]

Quote

You can also go to a big hospital here , no wait, guaranteed very big bill and bad medical advice and care

Must take exception to that as believe the chance of good/bad is just as great in any hospital IMHO and my experience.  And yes we have had experience in Chula (SIL was senior nurse there and wife had several operations there).  Upcountry private hospitals are often not staffed in the same league with those located in Bangkok - so would agree on that point however.  But in Bangkok many private hospitals are world class and treatment is second to none.    

 

Will add that there will almost always be a bad egg in every crate.  But the major hospitals value there international accreditations and take pains to maintain standards.   

Edited January 30, 2017 by lopburi3

[belshazzar]

War Doctors do you recommend at Chula? Thanks 

[Sheryl]

2 hours ago, belshazzar said:

War Doctors do you recommend at Chula? Thanks 

 

 Assuming you mean for prostate problem,

 

Prof. Kriangsak Prasopsanti

[nontabury]

On January 20, 2017 at 4:54 PM, R123 said:

Dr. Viroj Chodchoy at Bumrungrad   

 

And to address another poster my recollection was that the MRI cost was @ 40,000 baht; my insurance paid it.

I have just telephoned Bumrangrad. And I can confirm that yes the figure for the whole abdomen is 40,000 including contrast. Slightly less at Bangkok hospital Pattaya. Interestingly a staff member( not Doctor) at Bangkok, when I told her that I wanted the MRI for the prostrate, informed me that they perform a biopsy first before they'll do a MRI, this is the opposite to what is Now recommended in the West.

I don't know if it's a language problem,but I'm getting very confused as to what I should actually do. Last week the Dr at Bangkok Hospital,Bangkok also suggested a biopsy, this I refused,as again I have read many articles stateing that a MRI should be carried out first,yet I'm not so sure if some of these doctors know how to interperate the result. Any recommendation?

 

[soalbundy]

On 1/29/2017 at 11:23 PM, al007 said:

I am doing something a little unauthodox by replying to a private message in open forum, that I received a few moments ago, I have been very careful to see it remains anonymous, I do this because I believe we can all learn from this, and trust the sender of the message is not upset at me

 

I hope it all goes well for you

For the last few years My wife and I have had our 'annual' checks at Princhess Chulabhorn research Centre where you have been recently. This year we both had the 'tummy' Ultrasounds as they were on offer and it was suggested afterwards that I have an MRI (or another Ultrasound in 3 monthstime ... I went for the MRI and fortunately it was okay. I though both the ultrasound and MRI were very thorough .. both times the 'boss' was asked to have a looksee.

My PSA is fine at about 1.5/1.6 for a few years now, but I have quite a big Prostrate. Earlier in the year I had a 'look up' and a 'look down' at the same time.  That is my 2nd look up ... had one 5 years previous.

I'm interested in  your comment 'choose you doctor carefully' there.  How did you choose the Dr there please, and who?

FYI the are expanding and I have very recently also had a heart ultrasound and a treadmill straight after... cheap at about 2500thb!.

 

As I have said elsewhere I am very happy on my treatment at Chulalongthorn

 

I wound up there because Sheryl told me to go and see Dr Chucheep at his clinic at Bangkok Christian hospital, (at that time I was at my wits end and pretty desperate and very depressed, I received a lot of private message help) and I was lucky he saw me, and referrerd me to his radiologist Dr Chackapong, who I also saw at BCH, but then told me he wanted to do the radiotherapy at Chula, I also now see Dr Chuchcheep( who also does surgery at the Bumrungrad) at Chula

 

My treatment started at once at Chula, I could have had treatment at Khonkaen government hospital but was going to have to wait for a month and on far older less sophisticated equipment, with hindsight I am so happy I made the effort and went to Bangkok for the seven weeks of treatment

 

I believe Dr Chucheep, is one of the two top colorectal surgeons in Thailand, I have also seen his friend another top colorectal surgeon Dr Art Hiranyakas from Bangkok hospital in Phuket, for a second opinion, this man was recommended by another TV member

 

I believe I am getting the highest quality care and attention at government prices and very reasonable affordable cost

 

I am having another colonoscopy with Dr Chucheep late February, at Chula re the colon/rectum cancer, to see what the next move is

 

Yes Chula is building a state of the art new radiation centre, the place is just a building site at the moment

 

When at Chula recently and having food in their canteen, incidentally very nice and good quality food at penny prices; I got talking to the Sales Manager of Varian from Hongkong, who will being installing the new equipment, ( very high tech nuclear and millions or billions of batt) this is a joint venture with the UK and USA on manufacture, this man also told me Chulas existing Varian radiation technology is the best in Thailand, which I found very comforting

 

At the moment I am leaving the prostate alone, I am advised the radiation and chemo worked well there, it is not the urgent one

 

My philosophy of choose the doctor carefully,  comes from listening to Sheryl and others on TV

 

Again writing here concentrates my mind and when I next see Dr Chucheep I will ask him to refer me to a urologist for him to re evaluate my prostate situation at present my PSA is 0.75 down from 15.5

 

I also had Holep surgery in India for the prostate as I was getting up too much in the night to pee, and another TV member is also going to my surgeon there

 

I may sound a hyperchrondriac because of all my hospital stuff but until six months ago I only went for annual check ups probably every 18 months, and was on no medication, I never though I would get cancer yet alone two !!

 

I consider myself a very lucky man ! and have to say thank you  God

 

 

one day you can say that to him face to face no matter how many check ups you have

[Sheryl]

5 hours ago, nontabury said:

I have just telephoned Bumrangrad. And I can confirm that yes the figure for the whole abdomen is 40,000 including contrast. Slightly less at Bangkok hospital Pattaya. Interestingly a staff member( not Doctor) at Bangkok, when I told her that I wanted the MRI for the prostrate, informed me that they perform a biopsy first before they'll do a MRI, this is the opposite to what is Now recommended in the West.

I don't know if it's a language problem,but I'm getting very confused as to what I should actually do. Last week the Dr at Bangkok Hospital,Bangkok also suggested a biopsy, this I refused,as again I have read many articles stateing that a MRI should be carried out first,yet I'm not so sure if some of these doctors know how to interperate the result. Any recommendation?

 

 

I don't know where you are getting this from, but it is not correct.  Please re-read post #36.

 

What is true is that the very, very latest studies indicate that an MRI-guided biopsy (not MRI instead of biopsy!) is more accurate than conventional ultrasound-guided.

[nontabury]

10 hours ago, Sheryl said:

 

I don't know where you are getting this from, but it is not correct.  Please re-read post #36.

 

What is true is that the very, very latest studies indicate that an MRI-guided biopsy (not MRI instead of biopsy!) is more accurate than conventional ultrasound-guided.

From an article in the Guardian,19th January. It clearly states that a biopsy can be avoided altogether in 27 % of cases were cancer is suspected. It further goes on to say that the MRI can detect 93% of aggressive cancers,as opposed to only 48% with a biopsy.

MRI twice as likely as biopsy to spot prostate cancer, research shows

 

[Sheryl]

The article in the Guardian is reporting on a study in the Lancet which came out only 2 months ago.  The study;s findings and recommendations are, as usual, much more nuanced than the mass media report suggests: "The main findings suggest that if MP-MRI was used as a triage test, one-quarter of men might safely avoid prostate biopsy.".

 

As yet no health authority has adopted the use of MRI in place of biopsy as a recommendation, and they are unlikely to based on just this one study. Rather there will be more research, including cost benefit studies.  You are jumping the gun more than a little bit, and it is unrealistic to expect doctors here or anywhere else to do an MRI rather than biopsy on you.  Biopsy (often guided by MRI) remains standard practice at this time.

[nontabury]

17 hours ago, Sheryl said:

The article in the Guardian is reporting on a study in the Lancet which came out only 2 months ago.  The study;s findings and recommendations are, as usual, much more nuanced than the mass media report suggests: "The main findings suggest that if MP-MRI was used as a triage test, one-quarter of men might safely avoid prostate biopsy.".

 

As yet no health authority has adopted the use of MRI in place of biopsy as a recommendation, and they are unlikely to based on just this one study. Rather there will be more research, including cost benefit studies.  You are jumping the gun more than a little bit, and it is unrealistic to expect doctors here or anywhere else to do an MRI rather than biopsy on you.  Biopsy (often guided by MRI) remains standard practice at this time.

The Sperling Prostrate Centre in the States have been using this procedure for the last three years, also in the U.K. The Nottingham Urology Clinic amongst others. As you say,no health authorities have so far Not taken up this procedure, probably due to a small increase in costs. Allthough  there is a push for it's use,when they can make more MRI's available, and allowing time to teach their  staff to read the Multiparametre) mpMRI.

  

[bubba]

On 10/04/2017 at 3:45 PM, nontabury said:

I have just telephoned Bumrangrad. And I can confirm that yes the figure for the whole abdomen is 40,000 including contrast. Slightly less at Bangkok hospital Pattaya. Interestingly a staff member( not Doctor) at Bangkok, when I told her that I wanted the MRI for the prostrate, informed me that they perform a biopsy first before they'll do a MRI, this is the opposite to what is Now recommended in the West.

I don't know if it's a language problem,but I'm getting very confused as to what I should actually do. Last week the Dr at Bangkok Hospital,Bangkok also suggested a biopsy, this I refused,as again I have read many articles stateing that a MRI should be carried out first,yet I'm not so sure if some of these doctors know how to interperate the result. Any recommendation?

 

Just a note regarding MRI for prostate at Bumrungrad.

 

This gets rather technical, but to summarise:

 

There are two types of MRIs used for multiparametric prostate imaging. The older is 1.5Tesla with endorectal coil, while the newer technology is 3Tesla with pelvic array coil. (The Tesla unit being the strength of the MRI's magnetic field.)

 

3T MRIs provide much more resolution and sensitivity in detecting small PCa lesions compared to 1.5T. There is also the advantage of a more comfortable procedure with 3T MRI, since there is no endorectal coil up your backside for 30 - 40 minutes.

Be aware that Bumrungrad uses 1.5T with endorectal coil. They do not have the more modern 3T MRI. 

[nontabury]

1 hour ago, bubba said:

Just a note regarding MRI for prostate at Bumrungrad.

 

This gets rather technical, but to summarise:

 

There are two types of MRIs used for multiparametric prostate imaging. The older is 1.5Tesla with endorectal coil, while the newer technology is 3Tesla with pelvic array coil. (The Tesla unit being the strength of the MRI's magnetic field.)

 

3T MRIs provide much more resolution and sensitivity in detecting small PCa lesions compared to 1.5T. There is also the advantage of a more comfortable procedure with 3T MRI, since there is no endorectal coil up your backside for 30 - 40 minutes.

Be aware that Bumrungrad uses 1.5T with endorectal coil. They do not have the more modern 3T MRI. 

This confirms my inquiries regarding MRI in Thailand. Plus it seems to be less expensive elsewhere,certainly in India.

 

[nontabury]

My apologies, I should have replied earlier.

People may be under the impression that the recommendations regarding the mpMRI is a recent development,due to the article in the Guardian. However this is not so.  The National Institute for Care Excellence ( NICE) a government backed non departmental office giving guardiance and advice to the medical profession. Recommended in a paper,published in January 2014 that mpMRI should be used to investigate the presence of Prostrate cancer,as a more efficient alternative to a biopsy. This leads me to think,that the reason this procedure has not been fully adopted is due, to a lack of financial investment in these machines,and of course in the training of staff.

[teddog]

35 minutes ago, nontabury said:

My apologies, I should have replied earlier.

People may be under the impression that the recommendations regarding the mpMRI is a recent development,due to the article in the Guardian. However this is not so.  The National Institute for Care Excellence ( NICE) a government backed non departmental office giving guardiance and advice to the medical profession. Recommended in a paper,published in January 2014 that mpMRI should be used to investigate the presence of Prostrate cancer,as a more efficient alternative to a biopsy. This leads me to think,that the reason this procedure has not been fully adopted is due, to a lack of financial investment in these machines,and of course in the training of staff.

 

 

Could be right ,especially the last sentence.  No secret have just returned from India after having prostate operation ,but no cancer,if cancerous it would have focussed the mind more for sure.

  One poster suggests (The older is 1.5Tesla with endorectal coil, while the newer technology is 3Tesla ) for scanning is not available in BKK, I know not but a quick google of scanning prostate  (Chennai for example),   seems to be the Holy Grail of medical matters,the city,  suggest there is a later version of the T3 being ,or about to be used at a price that to say the least is a tiny fraction of Thailands exorbitant pricing structure

  Anyway its there,  just google whatever is wanted in the city its wanted and take a look.   Yes is daunting taking Thai as companion , I just leave mine at home,DIY sorta thing     Can also scan results of patient care in most hospitals there also,not so Thailand  may get locked up for bad reviews

Edited April 28, 2017 by teddog

[nontabury]

3 hours ago, nontabury said:

My apologies, I should have replied earlier.

People may be under the impression that the recommendations regarding the mpMRI is a recent development,due to the article in the Guardian 2017. However this is not so.  The National Institute for Care Excellence ( NICE) a government backed non departmental office giving guardiance and advice to the medical profession. Recommended in a paper,published in January 2014 that mpMRI should be used to investigate the presence of Prostrate cancer,as a more efficient alternative to a biopsy. This leads me to think,that the reason this procedure has not been fully adopted is due, to a lack of financial investment in these machines,and of course in the training of staff.

 

[bubba]

2 hours ago, teddog said:

Could be right ,especially the last sentence.  No secret have just returned from India after having prostate operation ,but no cancer,if cancerous it would have focussed the mind more for sure.

  One poster suggests (The older is 1.5Tesla with endorectal coil, while the newer technology is 3Tesla ) for scanning is not available in BKK, I know not but a quick google of scanning prostate  (Chennai for example),   seems to be the Holy Grail of medical matters,the city,  suggest there is a later version of the T3 being ,or about to be used at a price that to say the least is a tiny fraction of Thailands exorbitant pricing structure

  Anyway its there,  just google whatever is wanted in the city its wanted and take a look.   Yes is daunting taking Thai as companion , I just leave mine at home,DIY sorta thing     Can also scan results of patient care in most hospitals there also,not so Thailand  may get locked up for bad reviews

To clarify, I didn't say that 3T MRI is not available in BKK. I said it was not available at Bumrungrad since nontabury had mentioned phoning them about a prostate MRI. I know, because I endured their 1.5T MRI with endorectal coil last year. At that time, I was not aware of the differences and advantages of 3T MRI. I know no that at least Bangkok Hospital and Samitivej have 3T MRIs. I do not know whether they do multiparametric  prostate imagining or what their level of experience and competence is with interpretation. From the extensive reading I have done recently, the latter is very important.

[Sheryl]

12 hours ago, nontabury said:

My apologies, I should have replied earlier.

People may be under the impression that the recommendations regarding the mpMRI is a recent development,due to the article in the Guardian. However this is not so.  The National Institute for Care Excellence ( NICE) a government backed non departmental office giving guardiance and advice to the medical profession. Recommended in a paper,published in January 2014 that mpMRI should be used to investigate the presence of Prostrate cancer,as a more efficient alternative to a biopsy. This leads me to think,that the reason this procedure has not been fully adopted is due, to a lack of financial investment in these machines,and of course in the training of staff.

 

To my understanding it is not recommended as an alternative to biopsy but rather as a means of determining if biopsy is indicated.  If the results are suggestive of cancer a biopsy would still need to be done.

[al007]

An observation, no prostate biopsy is 100% accurate, even the 24 needle sample, when I had holep surgery in India; it was then, when the tissue cut out that a biopsy identified prostate cancer

 

So continue to monitor PSA , I have not heard of cancer being found with low PSA

[bubba]

On 28/04/2017 at 10:03 PM, Sheryl said:

 

To my understanding it is not recommended as an alternative to biopsy but rather as a means of determining if biopsy is indicated.  If the results are suggestive of cancer a biopsy would still need to be done.

I think the line between diagnosis and determination whether a biopsy is necessary is sort of blurred. Multiparametric 3T MRI is said to have a negative predictive value of 80 - 90 % for PCa, depending on whose study you look at. Given that,  I think maybe some urologists are using MRI as a diagnostic in a way. 

[bubba]

6 minutes ago, al007 said:

An observation, no prostate biopsy is 100% accurate, even the 24 needle sample, when I had holep surgery in India; it was then, when the tissue cut out that a biopsy identified prostate cancer

 

So continue to monitor PSA , I have not heard of cancer being found with low PSA

To the contrary – Low PSA does not rule out PCa and PCa accompanied by a low PSA is associated with high grade, aggressive cancer. To quote:

 

“An elevated PSA level is a well-known adverse clinical feature and is associated with a poor prognosis,” Paul L. Nguyen, MD, associate professor of radiation oncology at Harvard Medical School and director of prostate brachytherapy and clinical trials for genitourinary radiation oncology at Dana-Farber Cancer Institute, and colleagues wrote. “Nevertheless, high-grade disease is found even at PSA levels less than 4 ng/mL, and up to 10% of prostate tumors produce very small amounts of PSA.”

 

http://www.healio.com/hematology-oncology/prostate-cancer/news/in-the-journals/{e9a20b3a-1f7d-4390-b00b-44fc54af881c}/low-psa-levels-may-predict-aggressive-prostate-cancer-higher-mortality-risk

 

And:

 

Low PSA predicts poor prognosis in high-grade prostate cancer 

 

http://urologytimes.modernmedicine.com/urology-times/news/modernmedicine/modern-medicine-news/low-psa-predicts-poor-prognosis-high-grade-pr

[Sheryl]

5 hours ago, bubba said:

I think the line between diagnosis and determination whether a biopsy is necessary is sort of blurred. Multiparametric 3T MRI is said to have a negative predictive value of 80 - 90 % for PCa, depending on whose study you look at. Given that,  I think maybe some urologists are using MRI as a diagnostic in a way. 

 

The negative predictive value is not the issue, it is (1) the positive predictive value (since biopsy would be done if MRI suggestive of cancer) and (2) need  to determine the grade/aggressiveness, which only biopsy can do.

 

People are using Mp MRI as a means of deciding whether to biopsy. Though if it is decided not to biopsy based on negative MRI findings, the 10-20% risk that the negative predictive value implies needs to be kept in mind. A responsible urologist would explain that to the patient and it would be a joint decision to forego the biopsy, understanding that cancer while unlikely is not completely ruled out.

[Lumbini]

Here is another interesting article my friend just sent me about prostate screening . I personally think if one suspects a problem with things like a high PSA that has changed from low a few years back to high now the next step would be to do the non invasive MRI scan ASAP with Dr. Viroj Chodchoy at Bumrungrad as it's non invasive .

 

 

---------------------------

Research to cut unnecessary treatment for prostate cancer is ‘on fire’ | Fox

 

“There are a whole slew of blood and urine tests already available or on the way that can take a guy whose PSA is mildly elevated and tell him he doesn’t need a biopsy. How much could we drive down overdiagnosis? A lot.”

http://www.foxnews.com/health/2017/05/04/research-to-cut-unnecessary-treatment-for-prostate-cancer-is-on-fire.html