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.
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.