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Old 07-10-2010, 10:07 AM   #1
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New Abbreviation

Magnetic Resonance Imaging Spectroscopy (MRI-S)

It's a non-invasive diagnostic tool for determining if prostate cancer is present. It uses a strong magnetic field but also includes radio waves.

 
Old 07-10-2010, 10:45 AM   #2
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Re: New Abreviation

Quote:
Originally Posted by JohnR41 View Post
It's a non-invasive diagnostic tool for determining if prostate cancer is present.

Hmmm...actually, the only method used to confirm the presence of prostate cancer is the pathological analysis of a biopsy sample.

Before PC diagnosis, MRI-S (or other tools) can help to identify possibly likely locations within the prostate where cancer likely exists, and can help the doctor target the biopsy to those areas. The MRI-S "sensitivity" to PC is relatively high (reportedly in the 60-80% range), but a reputable doctor would not declare that PC is present based on a scan reading, but could declare that a spot is "worrisome" for PC, and follow-up biopsy may be warranted.

After PC diagnosis, the MRI-S can help determine the location and extent of PC. This is a possible tool for Active Surveillance patients to help monitor their cancer over time. Also, for patients pursuing treatment, the MRI-S can help to confirm the likelihood that cancer has not penetrated outside the capsule (and therefore surgery may be curative)...a possibly valuable tool in selecting surgery vs. radiation.

Color doppler is another, similarly useful tool.

Last edited by kcon; 07-10-2010 at 11:44 AM. Reason: added an "and..."

 
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Old 07-10-2010, 02:55 PM   #3
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Re: New Abreviation

Hi John,

This tool has been around for at least ten years now in a relatively mature form, but as kcon noted, it's not ready for diagnostic duties yet. A lot of us have been keeping an eye on this exciting technology, so I think that news of a breakthrough would have created a stir.

The technique is described with an excellent graphic on pages 57 and 58 of the Primer (original 2002 edition; almost surely within a page of that in the 2005 edition). The problem has been that the resolution, while good enough for some important purposes, has just not been good enough for diagnostic purposes.

The world leader in the technology at least in 2003 was Dr. John Kurhanewicz, PhD, then and probably still at UCSF. He presented to us survivors at the National Conference on Prostate Cancer 2003 in Long Beach, CA.

I just did a search of PubMed using " prostate cancer AND MRI AND spectroscopy " and got 423 hits. Adding Dr. K to the search (" prostate cancer AND MRI AND spectroscopy AND kurhanewicz j [au] ") yielded 75 hits, including quite a few free copies of the complete articles. One of the top ones, including a free copy of the full paper, is this:

AJR Am J Roentgenol. 2010 Jun;194(6):1414-26.
Prostate MRI and 3D MR spectroscopy: how we do it.
Verma S, Rajesh A, Fütterer JJ, Turkbey B, Scheenen TW, Pang Y, Choyke PL, Kurhanewicz J.
Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH 45267-0761, USA.

Dr. K is still at UCSF per the articles list of authors and their institutions. This article would give you a good grasp of the current state of the art, including a number of significant limitations that are noted in the "Discussion" section.

I haven't had time yet to try to find Dr. Wheeler's article that you referred to today, but I think between kcon's comment, my comment and PubMed you can probably answer the question.

Take care,

Jim


Quote:
Originally Posted by JohnR41 View Post
Magnetic Resonance Imaging Spectroscopy (MRI-S)

It's a non-invasive diagnostic tool for determining if prostate cancer is present. It uses a strong magnetic field but also includes radio waves.

 
Old 07-10-2010, 05:03 PM   #4
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Re: New Abreviation

MRIS is only effective with a 3 telsa MRI. Most institutions use a Telsa 1.5.
I had an MRIS at UCSF a few years ago which failed to detect a very large transition zone tumor. It was clearly identified with a color doppler and confirmed by a Telsa 3 MRI which I had in Holland.
JohnT

 
Old 07-14-2010, 09:32 AM   #5
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Re: New Abreviation

Quote:
Originally Posted by kcon View Post
Hmmm...actually, the only method used to confirm the presence of prostate cancer is the pathological analysis of a biopsy sample.
Ok, I accept the above statement as true.

Quote:
Before PC diagnosis, MRI-S (or other tools) can help to identify possibly likely locations within the prostate where cancer likely exists, and can help the doctor target the biopsy to those areas.
That statement seems to indicate that needle biopsies, without a "target", can miss finding the cancer. How many needle insertions would it take to search the entire prostate for cancer the size of a lentil?


Quote:
The MRI-S "sensitivity" to PC is relatively high (reportedly in the 60-80% range),....
What percentage of needle biopsies find cancer? If I remember correctly, about 85% find no cancer. And how many biopsies can a man have without causing undue harm (i.e. scarring).

Thanks

Last edited by JohnR41; 07-14-2010 at 09:55 AM. Reason: word change

 
Old 07-14-2010, 10:17 AM   #6
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Re: New Abreviation

Hi JohnR41,

I hope you get replies from the others who have been responding, but I'll add some comments in green.


Quote:
Originally Posted by JohnR41 View Post
Ok, I accept the above [as in a previous post - not carried forward by the software - about the necessity of a biopsy for a diagnosis] statement as true.

That statement seems to indicate that needle biopsies, without a "target", can miss finding the cancer. How many needle insertions would it take to search the entire prostate for cancer the size of a lentil?

There is the option of an exceptionally thorough saturation biopsy that samples every 5 mm, making it extremely good at finding cancer, its extent, shape and location. However, it is substantially rougher on patients than a standard biopsy, or a saturation biopsy with, say 14 to 20 cores. There is an alternative that I think you would prefer, which I'll mention below.

What percentage of needle biopsies find cancer? If I remember correctly, about 85% find no cancer.

About 75% of the time no cancer is found. Most of the time that's because there was no cancer, not because cancer was missed.

And how many biopsies can a man have without causing undue harm (i.e. scarring).

Thanks
I'm not sure of the answer to that, but I suspect the number is high.

However, an option I think you would prefer is a color Doppler ultrasound guided biopsy performed by one of the half-dozen or so experts in the US. The doctor who most frequently explains this procedure at the National Conference on Prostate Cancer series is Dr. Duke Bahn, who practices in Ventura, CA. (Other experts that come to mind are located in Minnesota, Florida, and Philadelphia.) The Prostate Cancer Research Institute, PCRI, a non-profit organization, has published an article about the CDU biopsy by Dr. Bahn in its free PCRI Insights newsletter. PCRI also has video recordings of the conferences that include his talks. Essentially, color Doppler works very well because a marker is used that is taken up by new blood vessel growth that is typical for growing tumors. It shows up as red in the ultrasound image, and this gives the doctor doing the biopsy a very important additional clue in choosing what areas of the prostate to sample. It also helps locate, size and determine the shape and nature of the tumor.

The drawback is that special high resolution equipment is required (not just any color Doppler ultrasound rig will do the job), and a high level of operator/biopsy performer expertise is also required. That's why there are so few places that do this. However, for the person willing to go the extra mile, I believe the rewards in information are great! You get a number of important facts that are just not available from standard biopsies. You are clearly in the school of thought described by the old carpenter's maxim: "Measure twice so you only need to cut once." I recommend you check into the CDU biopsy.

Take care,

Jim

 
Old 07-14-2010, 11:04 AM   #7
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Re: New Abbreviation

John, your questions seem largely rhetorical.
• How many needle insertions would it take to search the entire prostate for cancer the size of a lentil? Academic question? The well-known point you appear to be making is the possibility of a “false-negative” result. Similarly, results may be “under-graded” (Gleason score) if a positive biopsy fails to sample in an area of more aggressive cells.
• What percentage of needle biopsies find cancer? This one is answerable as there are studies which you could find on the web.
• And how many biopsies can a man have without causing undue harm (i.e. scarring)? The answer is going to be, “It depends.” Who is defining “undue harm?”
And from a separate thread:
• How many "needless biopsies" were there with the previous threshold and how many are there now? In other words, what percentage? Have there been any independent studies of this? The first half of this question is similar to one from above. How much improvement have the new (2009) “Best Practices” caused?...probably too early to tell.


I flipped back through some of your older postings, John, trying to figure out where you are in your prostate cancer journey so that I could better target a helpful response, but could not find any specifics....a lot of posting history on many other boards, but little on this Prostate Cancer board. Are we having an academic discussion here?

 
Old 07-15-2010, 09:49 AM   #8
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Re: New Abbreviation

Jim, Kcon, Johnt1,

Thanks for all the replies. I'm overwhelmed by it. Yesterday I tried to send a post to Jim to explain my situation and as I clicked on, "Quick Reply", the computer shut down at that very moment.

I began to realize that an impression was forming that I had PC. Believe me, if I had it I would have said so. I don't have PC but I'm concerned about it because my father and brother had it. I'm just trying to learn as much as I can in case I have a problem in the future.

I just received the results of a PSA test on Monday and I think the results were pretty good. See what you think. (I'll include all that I've had so far.)

YEAR:.....................PSA
2004----------------.93
2005----------------.90
2007----------------1.2
2008----------------1.0
2009----------------1.0
2010----------------0.8


If I may change the subject, a couple of years ago, I read a series of articles in my local newspaper. It was about a new facility that was being built in my area for radiation (PC) treatment. It was supposed to incorporate the very latest technology and be very accurate in targeting the cancer. (I just remembered this last night.) One of the articles stated that after every radiation treatment they would do an MRI-S (After all this time, I can't remember if it stated MRI or MRI-S but I think it must have been MRI-S.) So as the radiation shrinks the cancer they would be able to recalibrate to target a smaller and smaller area. If all of that information is true, the MRI-S must be highly accurate. Or were they just trying to sell it to the public?

Another subject: In June 2007, there was an article in the AARP Bulletin about a new blood test for prostate cancer that was developed by scientists at the Johns Hopkins University. April's Urology claimed a false-positive rate of only 3 percent. It was to measure blood levels of the protein EPCA-2. Here we are about 3 years later and I wonder what happened to that test. Does anyone know if it's being used?

Any and all comments are welcome.

Last edited by JohnR41; 07-15-2010 at 11:25 AM. Reason: Added a question

 
Old 07-15-2010, 02:17 PM   #9
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Re: New Abbreviation

Hi again JohnR41,

Good for you for being proactive in preparing for prostate cancer while trying to avoid it, or at least catch it early! I'll add some thoughts in green.


Quote:
Originally Posted by JohnR41 View Post
Jim, Kcon, Johnt1,

Thanks for all the replies. I'm overwhelmed by it. Yesterday I tried to send a post to Jim to explain my situation and as I clicked on, "Quick Reply", the computer shut down at that very moment.

I've been there, done that a frustrating number of times. I try to save frequently to a backup file.

I began to realize that an impression was forming that I had PC. Believe me, if I had it I would have said so. I don't have PC but I'm concerned about it because my father and brother had it. I'm just trying to learn as much as I can in case I have a problem in the future.

I'm sure you realize the odds of getting it, based on data from past years, are very high. However, while genetics are probably very important for prostate cancer in your family, it's important to realize that a gene or set of genes that promote prostate cancer likelihood is like a light switch: it can be switched on or switched off, and lifestyle tactics, plus, perhaps, mild medications, probably play key roles.

I just received the results of a PSA test on Monday and I think the results were pretty good. See what you think. (I'll include all that I've had so far.)

YEAR:.....................PSA
2004----------------.93
2005----------------.90
2007----------------1.2
2008----------------1.0
2009----------------1.0
2010----------------0.8

I don't recall that you've given us your age, and that makes a difference, but those numbers and the "trend" (basically no trend or arguably downward) do look good. The median for a man with a healthy prostate (no BPH, no infection, no prostate cancer) in his 40s is .7 (black and white); it is .9 (black and white) for a man in his 50s, and higher for a man in his 60s (1.4 for black men, and 1.4 for white men 60 and older). More to the point, prostate cancer, except in rare cases, is revealed by a tell-tale rise in PSA as cells divide, and obviously your PSA pattern does not show that.

If I may change the subject, a couple of years ago, I read a series of articles in my local newspaper. It was about a new facility that was being built in my area for radiation (PC) treatment. It was supposed to incorporate the very latest technology and be very accurate in targeting the cancer. (I just remembered this last night.) One of the articles stated that after every radiation treatment they would do an MRI-S (After all this time, I can't remember if it stated MRI or MRI-S but I think it must have been MRI-S.) So as the radiation shrinks the cancer they would be able to recalibrate to target a smaller and smaller area. If all of that information is true, the MRI-S must be highly accurate. Or were they just trying to sell it to the public?

MRIs, possibly MRI-S, and CT scans are used in these roles now in many modern facilities.

Another subject: In June 2007, there was an article in the AARP Bulletin about a new blood test for prostate cancer that was developed by scientists at the Johns Hopkins University. April's Urology claimed a false-positive rate of only 3 percent. It was to measure blood levels of the protein EPCA-2. Here we are about 3 years later and I wonder what happened to that test. Does anyone know if it's being used?

It is still pending. You could try this search " prostate cancer AND EPCA-2 " in www.pubmed.gov and get an idea of the current status.

Any and all comments are welcome.
Take care,

Jim

 
Old 07-16-2010, 09:34 AM   #10
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Re: New Abbreviation

Quote:
Originally Posted by IADT3since2000 View Post
[COLOR="DarkGreen"]Hi again JohnR41,

Good for you for being proactive in preparing for prostate cancer while trying to avoid it, or at least catch it early!
I'm afraid I can't take credit for trying to catch it early because my first test was at age 63. I was born in 1941; that's why I'm JohnR41.

I believe as you do that genes can be switched on or off based on lifestyle/environment. I was glad to here you say that; it's a very important concept. It means there's always hope, even in some of the worst situations. In the book, "The Biology of Belief", the author states: "Genes are not our destiny". Check it out, if you haven't already. It's a facinating read.
The author is Bruce Lipton.

Thanks for the information on EPCA-2. I'll check it out.


 
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