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Old 07-10-2008, 01:02 PM   #4
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Re: Diagnostic bone and CT scans: worthwhile?

Originally Posted by daff View Post
Jim- another viewpoint:

When I asked my urologist about getting an MRI, since I initially was headed for robotic surgery, I was told it's not necessary for low-risk patients....But my question is this: how does one conclude it's truly low risk when the chances of something like this are ever-present. And if one did have penetration beyond the edge of the capsule, and had surgery, there would have been a high liklihood of positive margins, so radiation might then be the logical step afterwards. So the middleman, surgery, could have been avoided under those conditions. I don't think surgery would have been the choice under those circumstances, but no one would have known until it was too late.
...So yes, overtesting is not good in itself, but how does one really judge what's necessary? I was a Gleason 7, by the way, when I was told by the urologist I was low risk. (I would have ranked me as intermediate.)
Hi daff,

Thanks for relating your experience.

I can easily accept that CT, bone scans and regular MRIs are not needed for low risk patients, but like you, I was surpised by Dr. Bubbley' extending that list to endorectal MRI. He is a well-known doctor, so he isn't giving an off-the-wall opinion. Perhaps there have been major developments since he wrote the text; considering that his book was published in 2005, he probably wrote it in 2004, and several years between then and now is a long time in prostate cancer technology in view of the rapid pace of developments. Perhaps adding spectroscopy to the endorectal MRI makes it a worthwhile approach, and perhaps he would have endorsed that combination approach if asked.

If I had been facing your situation with a Gleason 7, I too would have wanted some additional evidence, and the endorectal MRI with spectroscopy would be one of the logical choices. It seems odd to me too that the doctor described your case as low risk.

Did your earlier doctor raise the possibility of an endorectal MRI with spectroscopy? There are not very many facilities with the combined MRI and spectroscopic combination, so accessability may have been an issue in your earlier doctor's thinking. I know of one facility at UC San Francisco, another at Memorial Sloan Kettering in New York, and possibly one in Florida at the new site offering 3 Tesla MRI (not sure whether that is endorectal with spectroscopy). There may be more now that this technology is coming into its own. Where was your endorectal MRI with spectroscopy done? How was the test? I've heard some patients say it was okay, and at least a couple say it was really uncomfortable because of the endorectal probe and the length of time you are on the table.

On the other hand, I can understand ruling out a regular MRI. Dr. Myers wrote in May 2006 that CT and regular MRI scans were "completely inadequate" because studies show that they reveal only 15 to 30% of known lymph node metastases. That kind of track record would harldy give us the kind of reassurance we want! A CT scan can be useful as a triage type approach for a challenging case with strong likelihood of metastases, and that's why it made sense in my case. It's fairly quick and relatively inexpensive, and it does find large tumors. If you get a positive result, then you may not need more expensive and time consuming scans such as the fusion ProstaScint. (I was glad I needed the ProstaScint! )

I hope a Combidex scan facility is established in the US since that technology is so good at detecting lymph node mets anywhere in the body. As far as I have heard, the only competent facility now is in the Netherlands, though a group in the Boston area was working on it in recent years. Combidex, also known as USPIO and Sinerem, is a high resolution ultrasmall, superparamagnetic, iron oxide contrast agent MRI scan. It has not been approved by the FDA.