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    Old 07-21-2013, 10:03 AM   #1
    hcr
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    Multiparameter MRI Diagnosis Facility Help

    Looking for guidance. We live out of Country and my husband has a rising PSA now at 10.2 - I have been advised to get a multiparametric MRI of the prostate and avoid blind biopsies. I am new to this but gather the most important step is the first one. What guidance on costs and recommendations for Urologists? Florida would be easiest but I open to suggestions and can go to California etc

     
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    Old 07-21-2013, 10:43 AM   #2
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    Re: Multiparameter MRI Diagnosis Facility Help

    mpMRIs are usually reserved for second biopsies when the first biopsy was negative but something still seems to be going on. A standard 12-core TRUS-guided biopsy usually is a better first step and may be enough. It's important to eliminate other sources of rising PSA like BPH and prostatitis first. I don't know if PHI is available in Costa Rica as it is in Europe. If so, that is a very useful blood test. If not, % free PSA may be useful.

    I recommend a "periprostatic nerve block" before the biopsy - no pain, no anesthesia "fog." I also recommend that you have the biopsy slides sent to Bostwick or Johns Hopkins or other prostate specialty lab for a second opinion.

    If they can't explain the rising PSA, and they find nothing on the first biopsy, UCLA does a fused mpMRI/US-guided biopsy that seems to be very accurate. Duke Bahn in Ventura, CA does a color doppler ultrasound guided biopsy. Another second biopsy option is a saturation biopsy.

    - Allen

     
    Old 07-21-2013, 10:57 AM   #3
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    Re: Multiparameter MRI Diagnosis Facility Help

    Thank you. Have read many of your posts. Appreciate the help.
    Free PSA is 1.0
    Would you suggest head to one of the bigger Centers like John Hopkins / UCLA to start?

     
    Old 07-21-2013, 11:15 AM   #4
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    Re: Multiparameter MRI Diagnosis Facility Help

    No. I would get the first biopsy locally. A normal TRUS-guided biopsy isn't a highly specialized procedure. Only about 30% of first biopsies are positive for cancer. I'd save my money for later, if necessary.

    Last edited by Tall Allen; 07-21-2013 at 11:16 AM.

     
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    Old 07-21-2013, 11:51 AM   #5
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    Re: Multiparameter MRI Diagnosis Facility Help

    Forgot to mention - only 59 years old.

     
    Old 07-21-2013, 12:21 PM   #6
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    Re: Multiparameter MRI Diagnosis Facility Help

    That was about my age at diagnosis. Keep in mind that most prostate cancer is insignificant and indolent and does not require immediate treatment, if ever. You might want to read up about Active Surveillance before there is a diagnosis.

     
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