MRI/MRSI scans for PC

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Sonarman
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 12/15/2008 7:50 AM (GMT -7)   
I am particularly interested in MRI/MRSI scans for PC.  A year into my diagnosis, and with good ancedotal evidence that my PC is not progressing (declining PSA, continued clear DRE's, absence of BPH-like symptoms, etc.) for now, and an aversion to further biopsies, I am very interested in the potential for MRI/MRSI as a screening tool, and as a method to create an accurate baseline for future reference.  
 
Even more specific as I have studied the subject, the current state of the art appears to be the 3 Telsa MRI's using endorectal coils with MRSI.  It appears that these are available through UCSF, MD Anderson in Houston, Sloan Kettering and from Dr. Wheeler in FL.  The technology is expensive, and I am looking to find the least expensive approach, be that through a clinical trial or with billing via my health insurance. 
 
I would be very interested to read posts from anyone who has experience with MRI/MRSI as it relates to PC.
 
There is a good overview of MRI/MRSI relating to PC at the PCRI web site:
 
 
I am presently pursuing no treatments or surgeries, but have made major lifestyle changes and endeavor to monitor PC as carefully as possible, but non-invasively.  Weeks after my diagnosis, I adopted a strict macrobiotic diet, cutting out all sugar and sugar substitutes, all dairy products, all meat, hydrogenated vegetable oils, caffiene, etc.  I went from 187 lbs at diagnosis to 140 lbs, where my weight has remained steady for several months.  That's exactly what I weighed at the age of 25.  That delivers a lean but viable BMI and a six inch reduction in waist size.  As a side note, the cardio benefits of this have been phenominal.  I take supplements, but nothing in mega-doses.  I have adopted a pretty vigourus excercise program, and practice Yoga.  All of these seem to be making positive contributions, including a reversal of my PSA trend.  This is not the course recommended by the two urologists I have consulted, or by the surgeon (robotic) and radiation oncologist I interviewed post diagnosis.  I recognize that it is a road less traveled, and thus the interest in MRI/MRSI to get a better handle on my PC status.  

Age 59.  BMI 19.  BP 114/62.  Resting Pulse 58.
DX Date 12/12/2008 Gleason 6(3+3), T1C, 2 of 8 needles positive 40%/5% 
PSA:5/2000=1.2 3/2003=2.1 6/2005=2.3 4/2007=3.15 11/2007=3.20(PSA at DX) 
      3/2008=2.6 6/2008=2.1 8/2008=1.8 10/2008=1.8 11/2008=1.7
% Free PSA: 11/2007=16.0%(DX) 7/2008=22.0% 11/2008=17.0%
Current Treatment: Active Surveilance, Macrobiotic Diet, Supplements, Excercise, Yoga
       


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4168
   Posted 12/15/2008 10:49 AM (GMT -7)   

I had an MRI with endo rectal coils at UCSF about 1 1/2 years ago.  It took about 1 hour and wasn't too uncomfortable. It came up negative as did 12 previous biopsies.

This year I was diagnosed with a large transition zone tumor, 16mmX18mm that was obviously there when I had my MRI; so MRIs won't necessarily pick up a tumor, especially when it's located in the transition zone.

In my experience color doppler ultrasound was much more effective. I had two color doppler ultrasounds and both indicated the large tumor in the transition zone. A targeted biopsy confirmed the suspicion.

Using color doppler ultrasound a baseline picture can be established and targeted biopsies performed only when there is a change. Biopsies are only done in areas that are suspicious so a max of 6 samples are taken rather than a samples of 12 to 24 cores that are done in most biopsies. Color doppler can see areas of increased blood flow which usually indicate a tumor which need increased blood flow to grow.

The MRI at UCSF cost $4700, which my insurance picked up. I haven't been billed for the ultrasound and biopsy, but I think it will be about $1200.

Dr Bahn in Ventura Ca does color doppler and has done over 14,000 biopsies. He is exceptionally skilled, www.pioa.org. I was refered to him by Dr Sholtz, Prostate Oncology Specialists in Marina Del Rey Ca who also used color doppler, but does not do biopsies.

JohnT

 


Diagnosed 10-08 at 63 with PSA of 33
PSA was 4.4 in 1999 and has risen steadily.
Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6
2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.
Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.
Bone and CT scans negative.
PSA3= 43; high normal is 35
Currently evaluating treatment options, surgery is not an option as a high probability of positive margin exists.
John T


Sonarman
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 12/15/2008 11:11 AM (GMT -7)   
Appreciate your insight. That's just the sort of first hand infomation I seek.
Age 59.  BMI 19.  BP 114/62.  Resting Pulse 58.
DX Date 12/12/2007 Gleason 6(3+3), T1C, 2 of 8 needles positive 40%/5% 
PSA:5/2000=1.2 3/2003=2.1 6/2005=2.3 4/2007=3.15 11/2007=3.20(PSA at DX) 
       3/2008=2.6 6/2008=2.1 8/2008=1.8 10/2008=1.8 11/2008=1.7
% Free PSA: 11/2007=16.0%(DX) 7/2008=22.0% 11/2008=17.0%
Current Treatment: Active Surveilance, Macrobiotic Diet, Supplements, Excercise, Yoga
       


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/15/2008 1:25 PM (GMT -7)   

MRS and MRI are both available the the Nevada Cancer Institute, my primary care center.  I have had both and it was boring but not distressing.  I can see those not being in a tube not liking it, but it really was not much at all. 

I appreciate your watchful waiting approach.  (active surveillence may be more appropriate).  Terry Herbert, a internationally recognized PCa advocate, has used that approach for over a decade now.  The disease has finally started to affect him but he is still doing great.  He lives in Australia and he runs www.yananow.net.  You might want to contact him. 

I hope you stay and post updates.  Thank you for joining us here at HealingWell.
 
Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 12/15/2008 2:55 PM (GMT -7)   
I had an MRI and MRSI at the same time at MSK. The MRSI results did not come out because of "Patient Movements". I was very cold at the time and my insides were was shivering. Since I had already decided on surgery, the MRSI was not that important.
Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08 < 0.05


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/15/2008 4:03 PM (GMT -7)   
I most heartily endorse what Tony had to say about Terry and his YANANOW site. It has excellent treatment and progress charts of many members which can be looked here,
www.yananow.net/progress_chart.html
sorted at by age, initial PSA, Gleason or treatment type. A very knowledgeable man when it comes to PCa, his story can be read here
www.yananow.net/Mentors/TerryH.htm.
His latest endeavour is an excellent free online booklet, written in layman's terms and aimed at the newly diagnosed. He is a true and selfless advocate.
www.yananow.net/StrangePlace/index.html
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Post Edited (BillyMac) : 12/15/2008 4:06:02 PM (GMT-7)


melon
New Member


Date Joined Dec 2008
Total Posts : 2
   Posted 12/25/2008 9:42 PM (GMT -7)   

Hi hangin-in,

I like to know how long between your MRI/MRIS and your surgery.  Do you know if the MRI/MRIS procedure will affect the staging of the removed tissues especially the prostate.  A friend likes to have an MRI/MRIS before surgery in 10 days.  Thank you.

 


melon
New Member


Date Joined Dec 2008
Total Posts : 2
   Posted 12/25/2008 10:07 PM (GMT -7)   

TC-Lasvegas

Same questions, I really need to know if endorectal MRI/MRIS can be done only a few days before the surgery without affecting the prostate and the outcome of staging it after removal.  Any experience?  How long after your MRI did you have your surgery?

Thank you

 

 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/26/2008 9:32 AM (GMT -7)   
Hi melon, Sonarman,
This test can be done before surgery, but mine was performed after surgery. As part on entering a study for high risk advanced disease it was required. While I eventually did not enter that study, we were trying to see if any residual disease could be detected. It wasn't but my oncologist did not put too much into this type of imaging because it is not a perfect science either. Melon I think it was you that Emailed me yesterday. Sorry for the no reply to it yet. Yesterday was a busy day for me and family not to mention a holy day of obligation...

I am not certain that the information provided by these test results will affect treatment options often. This is why it is so rare. It is useful to know if ones lymphatic system is invaded, or if there is SVI detected, but that still may not deter surgery, radiation, or hormone therapy as options as there are compelling arguments to proceed with each treatment option anyway. But if you can get these tests and your insurance will cover them, then by all means get that baseline.  Many of the insurance companies won't cover this as the are least cost alternatives (LCA's) that are accepted by the medical community.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


Sonarman
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 12/29/2008 8:48 AM (GMT -7)   
Selmer -

Good to hear of another on the road less traveled.

I do take a long list of supplements. The original guy whose writings got me to consider diet, lifestyle and supplements is Roger Mason. I've studied his dissertations on Macrobiotic Diet (Zen Macrobiotics for Americans), Prostate Diseases (The Natural Prostate Cure) and supplements (The Supplements You Need). You can download any of his books at www.youngagain.org or buy them in healthfood stores or through Amazon, etc. His stuff just got me started, and I've since studied much of Muchio Kushi, David Ricketts, Edward & Wendy Esko, etc., etc. With reference to your question on diet, I am 100% macrobiotic, and have yet to encounter anyone who adheres more rigidly to those preceps. In a day, I cut out all dairy, all meat/animal protien (except small portions of fish), all sugar and sugar substitutes, caffiene, hydrogenated vegetable oils, chemically derived hair products and deoderants, etc. The "diet" is 50 - 60% whole grains (brown rice, barley, rye, oats, etc.), 30% cooked vegetables and smaller portions of nuts, legumes, fish and fruit. It was a radical change, but a year later, I haven't turned back and the ancedotal evidence looks good.... much reduced PSA and elimination of symptoms of prostate inflamation, not to mention exceptional cardiovascular numbers.

The only NSAID I take is one daily baby aspirin. I think of dropping it every now and then in light of my much improved cardio-vascular health. I take no prescription medications, and very rarely take ibuprofen or other NSAID's. When I do it's usually because of my having pushed a little too hard with some excercise or Yoga posture.

I can only recommend that people place more emphasis on diet and excercise. I may well be driven to more radical procedures to treat PC at some point, but based on my study, observations and experience, would think myself totally remiss, if I did not make every possible holistic effort to improve my odds. There is very little to lose by adopting at minimum a strict mediterranean diet if not going all the way to macrobiotics. And, properly done, the benefits become quickly obvious.
Age 59.  BMI 19.  BP 114/62.  Resting Pulse 58.
DX Date 12/12/2007 Gleason 6(3+3), T1C, 2 of 8 needles positive 40%/5% 
PSA:5/2000=1.2 3/2003=2.1 6/2005=2.3 4/2007=3.15 11/2007=3.20(PSA at DX) 
       3/2008=2.6 6/2008=2.1 8/2008=1.8 10/2008=1.8 11/2008=1.7
% Free PSA: 11/2007=16.0%(DX) 7/2008=22.0% 11/2008=17.0%
Current Treatment: Active Surveilance, Macrobiotic Diet, Supplements, Excercise, Yoga
       


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 12/29/2008 10:27 AM (GMT -7)   
My father had the endorectal MRI prior to surgery and the results showed that the surgeon would not be able to spare both nerves, but possibly one, which they did. The down side of the MRI was that the results were negative for lymph node involvement, which proved to be wrong based on the post op pathology. My father hated the endorectal MRI and I think knowing the accuracy of this particular test, he would have elected to not go through it. Everybody is different, and since I was not the one actually going through the procedure, I can't really comment on the test itself. As a family member, we were not told the accuracy of the MRI prior to the test, therefore, were devastated by the news of lymph node involvement following surgery. So, I guess my point is, that none of the tests are 100% accurate, or even 80%. Just something to keep in mind.
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 12/29/2008 2:48 PM (GMT -7)   
Sonar Man.....Do you drink Japanese Green Tea or Pomegranite Juice.? Pete has also changed his diet to almost what you are doing, although not as stringent as you seem. We eat meat once or twice a week. But, like you, he has given up sugar......The things that he has been reading have suggested that sugar feeds cancer cells. I admire your consistency and the rigorous diet plan that you are eating. We also are just trying to keep the PSA from rising faster. Pete has been through so many treatments, and now will have a total hip replacement this next week. It does seem strange that so much breast, prostate, and colon cancer has shown up in the past twenty five years..... The evidence is that fats, sugars, red meats, and who knows what else have become culprits in igniting the cancer that may be within us all.... Di
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
Waiting to see if AUS gets better results
Complete hip replacement surgery coming up Jan 9, 2009

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