Insurance usually pays for mpMRIs in a variety of situations (e.g., rising PSA after a first negative biopsy, active surveillance, recurrence after primary treatment) but not without a fight before a first biopsy. With the AUA's strong endorsement, I think they will be more likely to pay for it.
auanet.org/guidelines/mri-o...
But they highlight the importance of an experienced radiologist.
Well they are right about having a good radiologist. GG had an MP MRI before his biopsy and was told by the urologist as he was wheeled into the theatre, that everything "looked good". That, however, was not to be the case. We subsequently discovered the head honcho who looked at the scans and wrote the reports was on leave, and the 'understudy' had written the report and gotten it completely wrong. We had to pay for this, but we're in Aus. Would be great if the public health would spring for this test, as it's incredibly important. Thanks, as always, for sharing all this up to date info with us Allen.
Thank you for posting this article.
I have suffered shock then enjoyed relief and celebration from the same mpr MRI scan report In July 2019 using 4-year old Siemens 3T MRI machine (ie modern technology apparently).
Hospital radiologist in Kuwait where I had the scan reported that PCa cells were still there (following HIFU procedure November 2018.
Radiologist in London looking at same report (ie second opinion) reported I was clear of PCa - “subject to resolution”.
The London radiologist at Harley street clinic is familiar with my case and HIFU procedure.
When I questioned the different findings I was told that 3T MRI machine is good but that it depends how it is used and how the MRI operators look and search the prostate.
I had researched the MRI machines available in Kuwait and in london searching for the perfect MRI machines. Instead it was the operator who mattered (once 3T requirement was satisfied).
I think kuwait MRI operator was less knowledgeable than London and Kuwait radiologist was more pessimistic and less knowledgeable of HIFU procedure/outcomes. Whereas London HIFU surgeon and London radiologist know each other and work together regularly.
I have calmed down after the shock of Kuwait radiologists report. I took some time to believe london radiologist’s report that I was clear subject to resolution! That qualification worries me still.
I shall reread in depth the article and will try to use it to inform the Kuwait operators to get better resumption for next check MRI.
Thank you again Tall_Allen for your posts.
It's a steep learning curve, and it helps if the radiologist apprentises with an expert. It's particularly difficult to interpret the images if the tissue has been scarred by radiation or HIFU. Maybe someday it will be done by machine learning.
Thank you to Tall Alan. Yes the local radiologist seemed overwhelmed by the dead tissue from the HIFU procedure whereas the London radiologist is used to seeing post-HIFU prostate conditions. I hope he’s right.
As others have posted, will not rest on this London report, will keep PSA testing and will choose MRI scans by dedicated MRI clinic who hopefully have better experience.
MP-MRI is just another tool to be used in the diagnosis of prostate cancer. Like anything else in the hands of inexperienced radiologists some lesions will be missed. My insurance company did cover the procedure but I passed on a couple of facilities because they had only performed a minimum number of them. The one that I chose did around 10 MP MRI's a day.
Thanks for posting this.
I had mpMRI on a 3T machine before biopsy, which was interpreted to include probable EPE (soI was initially staged cT3a). Post-RP pathology downstaged me to pT2c -- ie no evidence of EPE. Great news, but on reflection (and after reading) I decided to ask for a second pathologist to look at the resected prostate. Post-RP pathology is the gold standard, but I still wonder about what the radiologist saw -- it's hard to interpret those images. The DCE images from mpMRI might have been affected by a leak of the Gd contrast agent during the +contrast scans -- felt like about 10 cc of fluid running over my arm!
Anyway, mpMRI is a great thing to get before biopsy, but it's not perfect.
You are so right! High false positive rate for EPE on MRI (from a third to 59% of all positives are false positives).
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