Prostate 3t MRI part 2
This is part 2, from previous discussion, same title.
**my first 3t MRI from June indicated PI-Rads4 lesion 12mmx9mm (UNM-Albuquerque). PSA in Nov 2021 5.4.
**I flew to Houston MD Anderson on 9/1 this month PSA was 5.2, basically the same after 10 months, slightly lower. They provided a second opinion on the MRI, but said PI-Rads 3, and increased the lesion size to 1.5x1.0. Biopsy still needed. Suspicion cancer or Prostatitis (new comment).
** I ran the MRI and all records by 2 other radiologists. Dr. Dan Sperling said it was poor quality and wouldn't recommend a decision to biopsy due to poor quality.
**The Prostate laser center in Houston- 2 radiologists reviewed the images and said they were not concerned with the previous lesion identified by UNM and MD Anderson, and said it seemed more like prostatitis which was mentioned in the opinion by MD Anderson.
But they referenced a different lesion as the index, and asked me to provide the slide locations back to MD Anderson for another look. PI-Rads 4.
What a conundrum!?
If MD Anderson doesn't acknowledge this different finding, not sure what the next step is to take. I definitely don't want a biopsy and they miss the index lesion altogether, ugh! I mean i understand I need to get the biopsy but not if they don't know which lesion needs to be biopsied.
What do you make of this mess, has anyone been in a similar situation?
thanks Team!
Hi
, you’ve mentioned poor quality image of MRI image, how about you propose for another MRI hopefully with better quality or even different MRI center as MRI procedure seems more tolerable in comparison to biopsy. Not sure if I’m making any sense here, but worth bringing it up. I had never heard of that, I will ask this Dr from Mayo is reviewing my case about this. I thought this type of imaging was done after they established cancer and wanted to know if there was any spread. But good to know. thank you! I wish you luck. In my case, 5 years ago, while I was under review for BPH, the Urology team wanted a TRUS biopsy done based on rising PSA and a middling free PSA score. But head of the team ruled in favour of a 68Ga PSMA PET scan, at that time a fairly rare procedure in my part of the world. The scan revealed a lesion which they labelled “suspected primary” and advised “histopathological correlation”. Then and then alone I got myself subjected to a TRUS biopsy which established a Gleason 3+3 Adenocarcinoma.
Even the 3T mpMRIs I had gone through subsequently while under Active Surveillance and which came up with a piRAD 4 lesion had advised “clinical correlation”. I had then undergone a PSMA-PET guided trans-gluteal biopsy which revealed some sort of progression in the disease leading to ADT and, in all probability, IGRT starting next month.
The point is it makes a lot of sense to establish the need for an invasive procedure beforehand.
While the word "cancer" is scary it is best to recall that in the world of cancers ---Prostate Cancer (PCa) --- is one that is slow growing and slow to reproduce. All of this potentially may give you some time to refocus on your next steps.
If the resulting images are not clear and you are concerned about undergoing a biopsy why not reschedule a new MRI in order to obtain a better view of what is going on.
I would also want to know the possible causes of the fuzzy MRI and ways to avoid a second fuzzy reoccurrence. I was told to lay very still during MRI scan. You might want to know if poor image quality was due to patient movement or some type of scanner issue. Dennis(ProstateCancer.net TEAM)The MRI centre staff, during my first mpMRI about four years ago, paused the process midway as they had detected some fuzziness. It was established that the digestive track needed to be cleared up. A couple of days of laxatives and activated charcoal tablets did the trick.
Even after my most recent mpMRI, I was recalled for a repeat of a sequence of scans as there had been some organ movement during the scan. A MRI centre has to maintain some vigil in respect of the quality of the process before finalising their report.
