I finally got my MP MRI. Had to travel 5 hours to find a facility that would do it that had a 3.0 Tesla MRI and would let me pay out of pocket. Best money I have ever spent. The results came back negative for prostate cancer and positive for chronic prostatitis. For those of you out there whose urologists fight you on getting this type of MRI over a needle biopsy you need to convince them otherwise. It may have cost me $750 but I found out I didn't have prostate cancer, was finally officially diagnosed with chronic prostatitis (reason for all the symptoms of prostate cancer including a free PSA of only 12%), got a very accurate prostate volume, and they also were able to check out my bladder and other neighboring organs. And, it only took 45 minutes, no pain, no bleeding and no chance of being hospitalized because of an infection from a needle biopsy. With the 4753 images they took in those 45 minutes they looked at the entire prostate and not just the peripheral portion, which is about all they can reach with the needle biopsies. Truly the way to go...
MP MRI finally...: I finally got my MP... - Prostate Cancer N...
MP MRI finally...
Why was it the best money you ever spent if the TRUS biopsy would have given you exactly the same results? Is it because you feel more confident about it? If you want to feel even more confident, there is a test called "Confirm Dx" that examines the biopsy cores to determine the probability that it missed some cancer.
With my chronic prostatitis a needle biopsy aggravates that condition. I had a needle biopsy several years ago and it left me almost disabled for several months. Without that it’s probably a toss-up which may be more accurate but I like the idea that the MRI scans the whole prostate.
Wait... So you didn't have a biopsy at all after your mpMRI? In biopsy-naive patients (like yourself) the negative predictive value of an mpMRI is only 70% - which means that 30% of the time it will incorrectly tell you you don't have prostate cancer when, in fact you do. Read this:
"This systematic review examined if multiparametric magnetic resonance imaging (MRI) scan can be used to reliably predict the absence of prostate cancer in patients suspected of having prostate cancer, thereby avoiding a prostate biopsy. The results suggest that whilst it is a promising tool, it is not accurate enough to replace prostate biopsy in such patients, mainly because its accuracy is variable and influenced by the prostate cancer risk."
europeanurology.com/article...
I'm all for avoiding unnecessary biopsies, but relying on an MRI alone is not the answer. Those interested in avoiding unnecessary biopsies where prostatitis is suspected are better off with blood tests, like PHI, or non-PSA-based blood tests like SelectMDx, or ExoDx Prostate Intelliscore.
For every article written in favor of TRUS or MP MRI there are a dozen that say the other is better. Most of the research studies done on the MP MRI are with the 1.5 Telsa machines and not the 3.0 (they now have a 5.0 and are testing a 7.0). The latest article I found was in January, 2019 and it clearly had MP MRI as a better method of detecting prostate cancer even with the older 1.5 scanners. But you are correct, there is still a chance of it being missed. That said, a TRUS biopsy misses 30% to 40% of cancers as well. Had my PIRAD score been a 3 or above with the MP MRI I would have gone for a TRUS biopsy, fortunately my score was lower and I also had a calculated PSAD of 0.10. I posted my opinion of the MP MRI to give men like me with chronic non-bacterial prostatitis another choice if they didn't want to risk months or years of pain and suffering that could result for a needle biopsy. Flare-ups with us can be caused by a stressful day or a long car ride, let alone having our prostate poked with a needle 12 to 16 times. In the end, we all have to make are decisions and live with the risks. I liked the MP MRI because of the simplicity and for me a actual image is worth more than a shot in the dark with a needle,,,and they took 4753 images. In addition the scan also looked at my bladder, lymph nodes, seminal vesicles and other surrounding organs. Also, I just found out my insurance company was now covering biopsy-naive scans since they are now convinced this is a viable method of detecting prostate cancer with the newer MRI scanners. I didn't know about the SelectMDx or ExoDx Prostate Intelliscore tests, nor did my urologist tell me about them. I will definitely look into these. Thanks for the info and for your replies...just wish we could find cures for these terrible diseases.
The issue here is not whether a TRUS-guided biopsy or an mpMRI-targeted biopsy is better, the issue is what you know without a biopsy. A TRUS-guided biopsy is a biopsy. mp MRI without a biopsy is not a biopsy. Any kind of biopsy beats a non-biopsy at finding cancer.
I couldn't agree more...hopefully with the advances in scanning that someday we can determine not only the existence of cancer but also the grade from a simple scan. I think we will get there. I guess my point is that the MP MRI is just another tool that helps determine whether or not a biopsy is needed. It's still an odds game but for those of us with chronic prostatitis (CP), if there is enough evidence that we don't need a biopsy, then good for us. At many times during our lives we have gray area psa, low free psa, and all the symptoms of prostate cancer (urgency, frequency, pain, burning, etc.) that prompts a urologist to schedule a biopsy every time we have a significant flare. If the MP MRI results in a low PIRAD score of less than 3 (or the other tests you suggested) and we don't need a biopsy then we can avoid the strong potential of crippling pain/infection caused by the biopsy itself. The MP MRI only gives us a score that equates to the chance we have cancer. I would strongly suggest anyone who has a PIRAD score from 3 to 5 get a biopsy. I haven't seen any studies on how many of us with CP could avoid a biopsy with the MP MRI, but for their sake I hope it's a lot of them. Thanks again for your concern and replies!
I can only repeat - the danger of not having a first biopsy and basing your diagnosis on just a negative mpMRI is that 30% of the time you will be wrong. It is not a good strategy to forgo a first biopsy just based on a PIRADS 1-2. Now, a second biopsy is a different story.
As far as NPV of 3TmpMRI, my urologist and radiologist both say it's closer to 80%, my radiologist saying a bit higher. However, I agree one has to look at the total picture. I am also biopsy-naive. My MRI was completely clear, negative. PIRADS 1. Also said with my large volume and uniformity I was consistent with BPH. However, the other factors contributing to my uro's foregoing a biopsy - for now - are the other facts. My PSA was rubber banding up and down, as low as 1.5 to 5.9 to 2.2, etc...and I had a low 4K result(7%) with a PSA of 3.9 at testing. I guess I am agreeing with you on cautioning that a biopsy may still be indicated at some point, and that in this person's situation possibly a 4K or other blood test would be another helpful data point. But again, I agree. MRI may not tell the whole story. But glad for this person's good MRI results.
Thanks Bassguy. Yeah, the 80% number is what my research has shown too and yes, the radiologists do have that number somewhat higher. But, even with that 80% NPV number my urologist also looked at my total PSA, PSA velocity, Free PSA, PSA density, family history, DRE, and a host of other stats before deciding I could forego a biopsy for now. I found you have to be careful where you get the MP-MRI. Several locations only do a couple of these a week. The facility I chose does around 10 a day and also make sure they have at least a 3.0 Tesla MRI. Most of the studies to this point have been with the 1.5 Tesla MRI's. It sounds like you have done your research and I'm thrilled to hear your results were good!
You guys are looking at the wrong NPV. The appropriate NPV is for patients who have not had a first biopsy (biopsy naive) - not for patients who have already had a biopsy (such as those on active surveillance). Table 3 in the reference below shows that for biopsy-naive patients the median NPV of mpMRI for was 69.9% across 8 studies (I have the full text).
europeanurology.com/article...
Allen, thanks again for your concern and information. I apologize if I have mislead anyone about the MP MRI. ALL I wanted to do was to let others know who have chronic prostatitis or that may be highly susceptible to infection, that an MP MRI is now ONE useful tool that they can add to the the multitude of other tests that may, and I repeat may, eliminate the need to have a needle biopsy,,, which could keep them from having weeks, months or even years of chronic pain. If you have never experienced this type of flare-up then you have no idea of the depression, anxiety, and grief it causes. I have had a needle biopsy several years ago and now the MP MRI. My urologist is a medical doctor with a highly ranked hospital and with the MP MRI and ALL the other test results, has told me I do not need a biopsy at this time. Nobody is suggesting at all to use an MP MRI alone to determine if a biopsy is needed. Nor do I believe that any qualified doctor would tell someone who has had only a negative needle biopsy that they absolutely do not have prostate cancer, given the more than 30% miss rate. Nor will I simply forget about my risk of prostate cancer and not continue to be diligent about keeping my testing current.
Thanks!
Thanks Tall_Allen, I hadn't heard of those other blood tests.
What I found was that PHI and SelectMDx are both about $300. You can get PHI w/o a doctor's prescription. The following study looked at 80 patients comparing both tests to their biopsies and found that SelectMDx had a > 90% NPV for detecting high grade PCa (Gleason score > 6). See the abstract for full stats.
ascopubs.org/doi/abs/10.120...
This year 2000 John's Hopkins report says they see biopsies miss 20% of PCa.
urology.jhu.edu/newsletter/...
FYI my PSA went from 4.9 to 9 to 5.0 over 4 months so we'll look at my PSA again in 2 months. However I also intend to get both mentioned tests done even if I have to pay for them myself. For some reason my urologist also mentioned the possibility of doing an mpMRI.
Bill
The last time I talked to the distributors (a couple of years ago), they quoted me $125 for PHI - but guaranteed that if insurance didn't cover it, they would pick it up. It is FDA and medicare approved.
PLEASE READ: the original post is BAD ADVICE! I highly suggest getting a 3T MpMRI as well, and get it first, before a biopsy. But if other indicatoins are there (like high, rising PSA) you shoud most definitely get a biopsy also. Currently, there is only one gold standard in determing PCa, and that's a biopsy. You cannot rule out PCa from an MRI - any type of current MRI. I myself got two MRIs. The second one being an advanced generation 3T MpMRI. My results were the exact same as yours and a biopsy further showed 4+3 PCa. An MRI is a great data point, but with current technology is not at all concusive. Once again, you get both. Just getting an MRI means little, and you can not declare anything conclusive from it.
Regarding my prostate volume estimation accuracy by various imaging methods.
- Initial abdominal US found it: "a bit over normal, 32cc"
- 3T MP MRI: 59.465cc*
- Axial CT: Didn't specify a volume figure but the prostate diameter mentioned was close to that of the MRI.
- Biopsy TRUS: 24.4cc
- Abdominal US just before RALP: ~40cc
- Finally the RALP pathology: 33grams, 35ml
*Note: They don't teach measurements during medical studies so doctors don't get annoyed by 3 decimal figures attached to a measurement that has, at best, 3-4 orders of magnitude inferior accuracy.
Not to mention that the ellipsoidal formula used for calculation is far away from the shape of the prostate. link.springer.com/article/1...
Lastly, assuming that the MRI machine were accurate to nanometers, they measure on a digitally sampled image having a maximum resolution of 512x512 pixels. The original higher order information (if there was any) was thrown away during the sampling process and can not be recovered.
Yet, if the computer prints a number, it should be accurate to any digit. Right?
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