Pelvis MRI

My husband will have in 3 weeks Robotic Surgery
for prostate cancer.
He already had bone scan and CT pelvis
That came up negative for metastasis.
His seurgon order Pelvis MRI before seurgery.
What could be the reason of this order if
He already had CT?

It may be helpful in planning for the surgery.

"Unlike CT scans, which use X-rays, MRI scans use powerful magnetic fields and radio frequency pulses to produce detailed pictures of organs, soft tissues, bone and other internal body structures. Differences between normal and abnormal tissue is often clearer on an MRI image than a CT."

More info if you search Google for "CT vs MRI"

Thank you very much for your reply.
Just wonder why he had to go to CT with
radiation if eventually in needs to
have MRI anyway?

Post Edited (Smara) : 11/7/2017 3:48:04 PM (GMT-7)

Smara-

It's probably not at all necessary and only runs up the costs. But if the surgeon wants it, he will order it.

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Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

ask the doctor these questions. Ask him what an MRI tells him that a CT does not.

And to address what may be motivating your question.....yes...ask him directly...."Did you order the MRI for planning the operation or for deciding on *whether* to operate at all?"

or something even more direct....(no softball questions....be as direct and honest as possible)

Lots of surgeons use MRI's for this surgery. The CT may have been ordered for confirmation of benign lesions found on the bone scan. Two areas on my bone scan were looked at more closely with CT's.

not uncommon.....at all

---

PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3 to 5 mm surgical margin 15% involvement pT2+
2/16-.01...4/16-.00...7/16-.00...10/16-.01...1/17-.01...4/17-.02...7/17-.02
10/17-.02

And don't be afraid of sharing your fears and sharing the motivations behind your questions.

the questions you've just asked are extremely legitimate (and easy to answer) questions for any surgeon going into any surgery.

(a doctor shouldn't have to be asked such basic questions....the information should be volunteered....not left to the patient to find out why....one man's pet peeve....I just couldn't let well enough alone)

Post Edited (island time) : 11/7/2017 11:26:25 PM (GMT-7)

Thank you so much to both.
I checked with the medic center that going to
Preform this test and they told me that it's
Actually going to be MRI Prostate (before surgery),
I don't know why on the order it shows MRI
Pelvis.

The MRI will show whether there is an extracapsular extension of the tumor.

George

MRIs are very bad at staging (like extracapsular extension) and should never be used for that. As of January 1, 2018 it will no longer be officially allowed (although I'm sure many will still use it). It won't tell the surgeon anything he won't see with the help of a pathologist standing by to take frozen sections. That is the thing you want to make sure of.

---

Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

My guess (from reading HW for some years now) is that in US, must be millions of people which are receiving drugs that aren’t helping them, and having various scans and tests that do nothing beneficial for them. You can also see this when comparing health cost in US with Europe.

Smara, I hope the surgery goes well.

Apologies to Smara for the OT rant

Gemlin-

Sadly, that is all too true, and everyone shares culpability - patients who insist on unnecessary tests and procedures, doctors who order them and tack on service charges, hospitals and facilities that encourage them and tack on more service charges, insurance companies and Medicare that rubber stamp and pay for them. I always ask, "how much is that going to cost?" and doctors look at me like I just landed from another planet. While "post-truth" was the OED word of the year, I've got to believe that "cost-toxicity" is not far behind.

---

Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

My husband had a MRI an it showed the cancer was contained in the prostate. That turned out to not be true. There was cancer outside at the apex. Isn't it somewhat possible that doctors order these tests to cover their rears because of how litigious our country is nowadays? If we could keep all of the lawsuits in check then I believe that healthcare costs would come down.

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PSA- 2014-4.3, 10/2016-5.7, 12/2016-6.3, 3/30/17-11.6
No symptoms, DRE-negative
Biopsy 2/17/2017 1/12 cores neg. 5% PC in 1. Gleason 4+4
MRI-3/29-tumor contained, no PI-RAD listed
4/28/17 Dr.Epstein confirmed G8
5/10/17 RALP Dr. Ahlering UCI. 2 large hernias found and repaired
5/16/17 cath out
Path- pT2c NX GL4+4, prostate 40 gr, tumor 1.5 cm. LFT Apical margin Prostatic
Adenocarcinoma GL4+4 2mm

My surgeon ordered an MRI with endorectal coil and contrast before the procedure. In our first post-op meeting, he said that MRI was extremely helpful when he was excising the prostate.

---

DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
10/2017 PSA < 0.1
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

Thank you everyone
My husband's seurgon said that
It's actually Prostate MRI and not Pelvis
MRI like maintain on the order.

I also would like to ask:

Do you usually meet with the surgeon right
before the seurgery?

Do you reccomend to send the pathology
to Epstein at John's Hopkins right after seurgery?

Post Edited (Smara) : 11/9/2017 8:39:30 AM (GMT-7)

Smara-
I met the surgeon (30 min) the day before the operation but on the big day I was already anaesthetized when the surgeon entered the surgery room. He visited me in the wake up room (10 min) and then the day after (45 min), before I left the hospital.
Sending the post surgery pathology for a second opinion is not needed and will not change the pathology report. Post surgery, it does not at all require the specific expertise and competence as we need for the biopsy slide readings.

---

Age at detection: 60
PSA 4.1 2014-02-25
Biopsy 2014-04-24, 4 of 10 cores positive, G: 3+4,4+3,4+3 EPE,4+3. PNI+
Bone scan negative
DaVinci 2014-08-31, nerve sparing right side
Prostate 35 g, 46x37x38 mm
Tumor dorsal PZ, SV-, 14 LN-, SM-, pT3a, G7 (4+3), EPE+ left side
PSA:
2014-10 <0.05
2015-03 <0.05
2015-09 <0.05
2016-03 <0.05
2016-09 <0.05
2017-09 <0.1

But do you think that it will be ok
To ask the seurgon (from Los Angeles) To send the surgical specimen to Epstein Right after the surgery?

I agree with Gemlin that it's not necessary, especially at a major hospital in a big city. It's only important with biopsy cores.

---

Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

What is the reason that post surgery pathology second
opinion is not necessary?

Post Edited (Smara) : 11/9/2017 12:18:30 PM (GMT-7)

Smara-
A pathologist can't miss if your pathology is so adverse that you should need immediate adjuvant radiation (ART). Even if there were a doubtful case you would be better of monitor PSA and have salvage radiation (SRT) when PSA is detectable and you see a trend. Your body needs to heal before radiation.

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Age at detection: 60
PSA 4.1 2014-02-25
Biopsy 2014-04-24, 4 of 10 cores positive, G: 3+4,4+3,4+3 EPE,4+3. PNI+
Bone scan negative
DaVinci 2014-08-31, nerve sparing right side
Prostate 35 g, 46x37x38 mm
Tumor dorsal PZ, SV-, 14 LN-, SM-, pT3a, G7 (4+3), EPE+ left side
PSA:
2014-10 <0.05
2015-03 <0.05
2015-09 <0.05
2016-03 <0.05
2016-09 <0.05
2017-09 <0.1

But what about to set GLesson Scores after surgery
It's not need just to confirm Gleason scores?

With a biopsy, they try to figure out Gleason score based on narrow cores that sometimes slice through tumors at odd angles. It takes an experienced eye to discern the correct Gleason pattern in those small samples. With post-prostatectomy pathology, they have the entire prostate to look at with all tumors intact - it's easier to get a correct Gleason score because they have so much more to look at.

---

Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Thank you to both for clearify it for me