endorectal mri

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Regular Member

Date Joined Nov 2009
Total Posts : 43
   Posted 9/7/2010 5:55 PM (GMT -6)   
We have heard encouraging reports about color doppler as a diagnostic device for prostate cancer. How about endorectal mri? Has anybody had success with this mri in identifying pca in cases where regular biopsies failed?

Veteran Member

Date Joined Aug 2010
Total Posts : 644
   Posted 9/7/2010 6:04 PM (GMT -6)   
I can only share my personal experience. I went for surgery to a highly regarded urinary oncological surgeon at Univ of California SF. Immediately after the initial consult he said, "let's check you out on the doppler ultrasound" (he didn't mention "color" -- I don't know if that matters.) After the doppler he told me that he could tell that the cancer was capsule - confined (which the path report later confirmed.) I asked him about the Endoretal MRI; he said "well, we could do that for you for free, since we have some research going on that would pay for it, but it's not as selective for this situation; even if it showed more extensive cancer I'd be inclined to believe the doppler over the MRI."

Again, that's just one data point.
DX at age 54 12/2009
Initial clinical profile: PSA 5.6, DRE-, high pre-op PSAV. Clinical stage T1c
Biopsy: Gleason 3+4 with PNI / 6 of 14 cores + / 10% of total length + / worst 45% +
TX: Robotic assisted RP 2/2010
Pathology: pT2cNx / Gleason 3+4 / PNI+ / SM- / SV- / EPE- / Tumor vol 7% / vol 40cc / 63 Grams
PSA - post-op 0.01

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 9/7/2010 7:36 PM (GMT -6)   
I had an MRIS at UCSF after 11 negative biopsies. It come up clear. After another negative biopsy I had two color doppler ultrasounds and both showed a large tumor which was biopsied as positive.
I asked my doctor about the negative MRIS and he said it was good at picking up cancers near the surface of the prostate, but was not good at seeing tumors that were in the interior.
I also asked Dr Barantsz, the leading researcher in prostate cancer imaging, and he said that Telsa 1.5 MRIs were not very good at spotting tumors and you need at least a Telsa 3.
I think that the biggest advantage of a color doppler is that you can immediately biopsy any suspicious area and actually see the biopsy needle track to see if you hit it. With an MRIS if a suspicious area is located you must go in for a biopsy and there is no way they can tell if the tumor was hit as they can only biospy the general area and not a specific spot. With a color doppler samples are taken from the edges of the tumor and also from the center so you get a real good idea of it's gleason composition. If a bopsy just hits the edge it can appear to be a gleason 6 where as the center is a G7. This is exactly what happened in my case.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


Regular Member

Date Joined Nov 2009
Total Posts : 43
   Posted 9/8/2010 2:35 PM (GMT -6)   
Nobody has anything good to say about the mri. That is an interesting result.
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