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Old 06-22-2012, 07:20 AM   #1
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MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Here is my history. Have been lurking for a while.



Age 58



2003 PSA 1.5 CMIA Method

2005 PSA 1.3 CMIA Method

2008 PSA 1.8 CMIA Method



Nov 2010 PSA 2.3 CMIA Method

March 10, 2012 PSA 3.1 Siemens Chemiluminescent Method

May 03, 2012 PSA 3.35 Vitros Immunodiagnostics Immunometric Method

May 25, 2012 PSA 3.60 Beckman Coulter Immunoassay Method.



May 25, 2012 Free PSA = 14%

June 04, 2012 PCA3 = 29 Avero Diagnostics - Cutoff = 32

DREs, family doctor said he felt a nodule (this is how the whole thing got started), two Urologists said no nodule???



MRI will be on Wednesday, June 27th.

Color Doppler US (without biopsy) scheduled for Friday, June 29th.



Biopsy decision will depend on the results of the MRI and the Ultrsound.





Suggestions and comments welcome.



AKAI.

 
Old 06-22-2012, 12:55 PM   #2
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hi Akai,

Family doctors are notoriously bad at doing DRE's. Urologists are much more experienced at it and often take more time. MRI will almost certainly show nothing. If you're going to do an MRI, at least do one of the parametric MRIs now available. Your free PSA and PCA3 are certainly not indicating a problem. And your very slowly rising PSA is certainly not an issue. The color doppler cannot distinguish between cancer and calcifications unless the cancer is far gone and is creating its own blood supply.

By a certain age, most men will have some prostate cancer, but it is usually insignificant and indolent. My personal belief is that men too often rush into biopsy and then are troubled by having to deal with the results. Why not wait until your PSA and other biomarkers are indicating a problem? You didn't mention your prostate size, but it is certainly possible that it is enlarged, and that finasteride or dutasteride can help clear that up. They will also help by re-establishing a clean baseline PSA reading, which improves the diagnostic accuracy of the PSA test. I would take it for at least 6 months and re-track PSA from that point on. You can re-visit the biopsy decision if PSA is not reduced or continues to grow while taking it.

- Allen

 
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Old 06-22-2012, 05:03 PM   #3
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Thanks Allen. I think my prostate size is normal per my Uros. I am disturbed by three different methods used in testing my PSA during the last two months which makes comparisons less meaningful (based on Dr. Walsh's book). Somehow both Uros were not that concerned about different labs and different methods, I do not know why. Had it not been for the family doctor supposedly detecting a nodule, I would not have gone through all these tests and procedures.

Akai

 
Old 06-22-2012, 07:29 PM   #4
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Where do you live that you can get an MRI, US, and PCA3 before a biopsy? Not a bad idea but most USA urologists won't order those on a person that has never had a biopsy and has an elevated PSA. What kind of MRI are you getting? 1.5 or 3 tesla? With or without endorectal coil? Where will it be done?

The following information may be of value:

http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf

The stuff about PSA is good. Pay particular attention to the data on the prevalence of prostate cancer in men age 55 and older with PSAs below 4.0. Its in a table.

Unfortunately, the right answer regarding whether or not to get a prostate biopsy may only be known in hindsight.

 
Old 06-22-2012, 08:01 PM   #5
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Starr15: I am in SoCal, I belive my MRI is T3, endorectal, with and without contrast, will be done at USC.
My Uro and I had a long discussion on what steps are available before a biopsy. I wanted to make sure that if biopsy is needed that it is for my best interest. I asked for all these tests based on a thread I read on a website under "In a perfect world, what tests would I like to have done before a biopsy"

He will be using all of these results (MRI, color doppler US), if/when a biopsy is warranted.

Akai

 
Old 06-22-2012, 09:55 PM   #6
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Dr. Ukimura at USC has a lot of great tests that he is very expert at, including color doppler US, elastography, and others. Your family doctor may have put you through a lot of unnecessary worry, which I'm sure would be a big relief to you. Yes, it would be nice if your PSA tests had been all the same, but I agree that it is not a big deal -- as long as you haven't been treated, there is more natural variation in your PSA than there is in the tests. I think you are wise not to rush into biopsy.

- Allen

 
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Old 06-23-2012, 05:39 AM   #7
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

I had a similar pattern of slowly rising PSA a year ago, PSA up to 3.5. Normal DRE. Local Urologist suggested biopsy. I deferred. Got a consult at a major internationally known academic center. The PSA there was 2.7. I was relieved, but they too suggested biopsy. I decided not to get a biopsy at that time. They would not offer an MRI. They would not offer PCA3 either. Managed to get a PCA3 anyway. It was 20. 6 month follow up PSA was 3.2. Now PSA was 3.8. Got another PCA3. This time it was 10.
After much anguish and postponing 2 biopsy appointments, i went ahead and got a biopsy
last week. Will let you know.

 
Old 06-23-2012, 08:07 AM   #8
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hi Starr15, was it a color doppler guided biopsy? I, like you, am also worried about missing detecting cancer early but I also don't want to subject myself to an unnecessary procedyre. It is unfortunate that there is no better test available. City of Hope is almost done with their clinical test on a biomarker, hopefully it will be available to the public soon.

Please come back and keep us posted. I wonder how many percent of the biopsies turned out negative, we usually never hear from them.

Akai

 
Old 06-24-2012, 08:49 PM   #9
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hello Akai,

I too was disturbed when my PSA was bouncing around and different labs were being used. Found out one lab was using a Vitros 3600 immunoassay machine and the other Beckman Coulter. Digging on the internet indicated the predecessor to the Vitros machine used the W.H.O. standardized material to calibrate for PSA tests. Beckman Coulter uses the Hybritech standardized material. The different standardized materials will give a PSA result that differs by approx. 20% on the same blood sample. I did a rough verification of this by having a blood sample run on Beckman Coulter w/ result of 3.9 and one week later a second sample run on the Vitros w/ result of 3.17. To me, the patient, the different results of these machines is not trivial.

Your May 25 PSA, had it been run on the Vitros machine, would probably have been less than 3 i.e. a drop from the May 3 test. However, I have all my PSA's now run on the Beckman Coulter because it can provide the free PSA also.

This is my first post so not sure if my signature profile will show up on the reply or not. In any event diagnosed early 2012 with total PSA of 4.4 and free PSA 14%. Color doppler ultrasound found the tumor immediately. I am a strong supporter of color doppler ultrasound. One tumor contained within the prostate. All other biopsy sticks were negative. Gleason 3+3. Brachytherapy June 2012. 24 needles and 72 stranded seeds. I-125. 2.5 weeks since seed implant and no noticeable side effects. Side effects should build through the second month then begin a gradual recession to nil around mid 2013. I was never seen by a urologist. I did all my own research and decision making. Made all my own contacts. I knew that if the cancer was contained in the prostate I'd go for Brachytherapy and if it wasn't then I wasn't a good candidate for surgery anyway. At least that's the way I looked at it.

Robert

 
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Old 06-25-2012, 10:01 AM   #10
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Robert, thanks for sharing your experience regarding the PSA testing methods. I will make sure to ask what method they are going to use for my next PSA test. The last PSA test was done with Free PSA at Quest Diagnostics.

 
Old 06-25-2012, 10:18 AM   #11
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hi Akai,

Quest is who I use. When I have blood drawn for a PSA test I always make sure the tech knows I want the total and free and the sample is to be sent to Quest lab.

Robert

 
Old 06-26-2012, 07:34 AM   #12
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hi Rober, how did you get the lab to do thest tests without an order from a doctor? I tried that once and they would not do it. Also, the results go directly to my doctor, they won't give the results to me directly. Quest does have an app called Gazelle (iphone) which allows you to access your test results as well as management your health care but your doctor must participate in the elctronic program and must sign off on allowing you direct access. My doctor does not participate in this program so I always have to have the doctor's office fax me a copy of the results.

 
Old 06-26-2012, 08:12 AM   #13
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hello Akai,

Did not mean to mislead. All blood draws are at my local primary care physician (PCP). The PCP sends me a copy of the Quest results.

Robert

 
Old 06-26-2012, 09:18 AM   #14
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hi Akai,
What is really important is to improve the diagnostic accuracy of the PSA test and develop a baseline trend that gets rid of the confounding effects of prostatitis and BPH.
In the following study the researchers gave men an antibiotic and an NSAID to diminish prostatitis. I think the NSAID was a good idea, since some prostatitis doesn't respond to antibiotics. As you can see, it has a very large effect. Adding in a 5ari can reduce your PSA by half. Together they may eliminate unnecessary biopsies for you.
http://www.ncbi.nlm.nih.gov/pubmed/22729607
http://www.ncbi.nlm.nih.gov/pubmed/21074214

- Allen

 
Old 06-26-2012, 10:20 AM   #15
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Re: MRI appntmnt nxt Wed & Color Doppler US nxt Fri - What should I watch out for?

Hi Allen:
My first Uro prescribed Trimethoprim for six weeks eventhough he found no nodule and believe my prostate to be of normal size. He had my PSA history up to the 3.1 score. During that time I also had a surgery to remove my gall bladder and the Trimethoprim was interrupted for a few days while I was on a different antibiotic. The PSA result after the Trimethoprim treatment was 3.36, but it was done at a different lab using different method than the 3.1 score. He wanted to do the biopsy based on my 3.1 PSA score but I decided not to until I get other tests done before I decide that it is necessary. That is when I decided to see Dr. Ukimura at USC. Dr. Ukimura first reaction was to do a biopsy within six months, he was not rushing the biopsy, I asked for all the tests that can be performed (PCA3, MRI, CDU) before a decision to do a biopsy, he agreed, and I am in the process of completing all the three tests. Dr. Ukimura and I will reiview all the results together and a decision will be made whether a biopsy is warranted.

 
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