Combidex MRI update

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John T
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Date Joined Nov 2008
Total Posts : 4188
   Posted 2/13/2009 2:43 PM (GMT -6)   
Here I am in cold wet Holland waiting for the 2nd day of my Combidex MRI. The first day was the IV of the imaging agent, I have to wait 24 hours for the agent to get into the lymph nodes then take the MRI. The great thing was that I got to spend about 90 minutes talking to Dr Barentsz about PC imaging. He's by far the world's foremost PC imaging researcher and developed the Combidex MRI. I got a lot of information about the latest in PC imaging.
Combidex MRI is used to image intermediate and high risk PC patients for lymph node involvement. It uses nano iron oxide particles as an imaging agent. The cancerous lymph nodes won't allow the agent to enter so the node appears different on the MRI. It's 96% accurate in identifying lymph node metz. CT scans are next to worthless seeing only the largest tumors and PET scans can't see PC at all.
There are obvious advantages in knowing if you have PC in the lymph nodes before any treatment. In Surgery for high risk patients a sample dissection of lymph nodes is usually taken. This cost more and has physical consequences for the patient. If you can eliminate this sampling it is of great benefit. Dr. Barentsz mentioned that he recently discovered that when lymph nodes are surgically sampled they are taken from the main pelvic string of nodes. There is a second string of nodes that is rarely sampled. His data shows that 40% of the time this node string is positive for PC while the primary string is negative, this is true expecially if there is seminal vessel involvement. Since this is rather new information most doctors don't know about it.
In radiation high risk patients usually have all the nodes radiated just to be on the safe side. This can also be eliminated or the cancerous lymph nodes can be identified and specifically targeted.
You can use the nonograms to determine your risk for lymph node involvement and make a decision based on your own tolarance for risk. Dr Barantsz requires a minimum gleason 7 and PSA of over 10. He has done over 1,000 Combidex MRIs in the last three years and Holland is the only place in the world that it is done. He and his assistant independently read every MRI and resolve and differences, since the MRI reading is a highly skilled task. All the images are sent to you within a week on disks and all lymph nodes are highlighted, green meaning good and red meaning PC.
The cost of the procedure is 1900 euros or about $2500 and payable by check at the time. It is done at ST Radboud Medical Center in Nejmegen, which is about a 90 min train ride from the airport with trains leaving every 30 min.
There is about a 45 to 60 day waiting period and you cannot take any hormone drug before the test as it will nulify any results.
It will probably take 3 or 4 years to get FDA approval for the imaging agent, so this procedure will only be available in Holland for the next couple of years. People from all over the work are coming here for the procedure.
 
Dr Barentsz is currently working on fusing 4 different MRI images with ultrasound to give a much more accurate picture of the prostate. This prodedure should be available on the West Coast, LA area, within a year. It will have a great benefit to those patients who are on watchful waiting or who have had multiple negative biopsies.
 
If you are at high risk for lymph node involvement this procedure is definately worth investigating with your doctor. If you need any information on who to contact or logistics questions please e mail me.
I'll post my results in a week.
JohnT
 
 

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/13/2009 3:42 PM (GMT -6)   
Hi John,
I am excited to hear the results of the test. Stay dry, and stay well. And I will stay tuned...

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/13/2009 4:21 PM (GMT -6)   
John, I hope it goes well. I hope to see Holland which is my ancestral home someday.

Why is the Combidex superior to a Prostascint?

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/13/2009 4:37 PM (GMT -6)   
Prostatscint can give false positives is one of the problems and that would be a big one right there, I doubt false positives with this proceedure, but I don't know for fact. I did ask my support group what they might know of this combidex method, although it is probably an excellent scanning method. The question still remains at how insignificant..how small..can this detect...i.e. can it miss some PCa...???
I happy you are doing this John as it may well be the assessment you need to make a good judgement call on your future and treatments. I would guess that if it were here, alot of people would say forget the other scanning methods, nano-tech already seems to trump such others, atleast just in theory alone.
We all will be interested in what can be revealed by such method.

Z-Bob Dx-2002
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/13/2009 5:31 PM (GMT -6)   
zufus said...
Prostatscint can give false positives is one of the problems and that would be a big one right there, I doubt false positives with this proceedure, but I don't know for fact. I did ask my support group what they might know of this combidex method, although it is probably an excellent scanning method. The question still remains at how insignificant..how small..can this detect...i.e. can it miss some PCa...???

 

?


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/13/2009 5:37 PM (GMT -6)   
Ever had a prostascint? The isotope idium 111 is rather predictive. The problems have been largely with the fusing and registry of the PET and the CT scans.

Not at all what you have described.

Scott


Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/13/2009 5:41 PM (GMT -6)   
Hey I can yield to your knowledge on prostascint, no problem. The books and such say it can give false positives, other than that hey it might be one of the better ones. Perhaps you would like to talk about it, I don't know much about it other than what I have seen on forums over 6 yrs. or so. It does seem to appear that no scan method within the USA is as definitive as we need to see or find.
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 2/13/2009 5:49 PM (GMT -6)   
John,
I hope all goes well for you and you test finds no lymph node involvement. Keep us posted.
Age: 67
5ft 10 inches 182 lbs
Retired in 2001 and living in Austin TX.
Dx 12/30/08
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
12 sections tested 2 with cancer
Left Medial Apex 4.0 mm. Gleason score 9 (4+5)
Left Lateral Apex. 2.0 mm Gleason score 8 (4+4)
Negative CT scan and bone scan done on 1/16
PSA 3.5


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/13/2009 6:00 PM (GMT -6)   
zufus said...
Hey I can yield to your knowledge on prostascint, no problem. The books and such say it can give false positives, other than that hey it might be one of the better ones. Perhaps you would like to talk about it, I don't know much about it other than what I have seen on forums over 6 yrs. or so. It does seem to appear that no scan method within the USA is as definitive as we need to see or find.

Thanks, your reply speaks for itself.
 
Scott
 
sorry for the hijack John.  I hope you are enjoying your trip and that the Combidex gives you a direction.
 
Scott

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/14/2009 1:34 AM (GMT -6)   

Scott,

From what I've read and what my Doc told me , prostaScint with CT fusion is highly inaccurate. It can only pick up larger tumors and gives a lot of false positives. The initial trial of Combidex was three years ago using 370 patients who had scheduled surgery. They were given the scans a week before surgery then lymph nodes were removed and sent to path. The scan was 96% effective in indentifying nodes with no PC. There were a few false positives, but these were mainly the result of the skill of the reader rather than the scan.The original trial was done across 5 Dutch hospitals and there were differences in results by hospital, the teaching hospitals scoring higher in effectiveness.

The lesson is that the skill of the reader is just as important as the technology.

JohnT


I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/14/2009 1:42 AM (GMT -6)   
Scott,
On the PET scan, the isotope doesn't like to bond to PC cells like it bonds to other cancer cell. In Melenoma and Breast Ca PET scans show up like tiny searchlights where ever there are cancer cells. No affect at all on PC cells.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/14/2009 10:20 AM (GMT -6)   
John T said...
Scott,
On the PET scan, the isotope doesn't like to bond to PC cells like it bonds to other cancer cell. In Melenoma and Breast Ca PET scans show up like tiny searchlights where ever there are cancer cells. No affect at all on PC cells.
JohnT

To clarify my meaning on this point.  All nuclear scans are PET scans, the particular isotope used is chosen depending what the Dr. is attempting to image and determines the exact title of the PET scan.  PET is a generic acronym.
 
I have had two prostascints, MUSC relies heavily on it and has belief that the earlier issues with ambiguous results have been resolved with the newer equipment they now employ.  Interesting enough Duke Medicine does not employ prostacint in their diagnositc process.
 
I have just seen your update and hope the scan proves useful to your Drs.  Good luck.
 
Scott

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/16/2009 4:31 PM (GMT -6)   
Scott,
What did your prostascints reveal?
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/16/2009 5:06 PM (GMT -6)   
John T said...
Scott,
What did your prostascints reveal?
JohnT

Hi John,
The first one post surg, I was told looked like positive for prostate cancer negative for lymph involvment, the Dr. said it looked like a pre surgery scan for a man with prostate cancer.  But of course prostascint does not diferentiate between normal and cancerous prostate tissue, it simply atttaches to a protein expressed by prostate tissue.
 
The second one was negative both in the region of the prostate and the lymph.  This has been puzzling as I have this persistance of PSA (1.7) and the prostascint should have detected activity in the region of the remaining prostate tissue and did not.  Who knows may be the protein is more effected by the radiation than the PSA???
 
This is why I have been so insistant on determining what the source of my PSA is as there has been no indication of distant mets.
 
I get you on the variablilty of these newer scans and all I really know about prostascint is what my Drs. have told me. 
 
I hope you have a more predictable outcome from the Combi scan.
 
Scott
 
 

Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/17/2009 1:59 PM (GMT -6)   
Scott,
You have a unique situation with prostate tissue still around. In My discussions with Dr Barantsz he said they did a lot of reasearch on PET and couldn't come up with any reliable method to identify PCa using various isotopes. I think UCLA is working on some stuff that combines MRIS with DCE and some type of wide diffusion MRI. The combination should be able to identify PCa from normal prostate tissue. You may want to give them a call and check it out. I think if were in your lymph nodes it would be creating more PSA.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/17/2009 2:12 PM (GMT -6)   
I just ran across a new article on the Combidex MRI and the problems in getting FDA approval. It's in the march issue of Life Extension magazine, www.lef.org.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT

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