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MpMRI questions

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Prostate Cancer
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Posted Today 9:43 AM (GMT -5)
Hello all
Psa 2.2 4+3 one core 3+4 seven cores 3+3 two cores

All thank for the reponses. I sent my Epstien path report to:


Jonathan Hwang, MD

Chairman, Department of Urology
Medstar Washington Hospital Center

Associate Professor of Urology
Georgetown University School of Medicine


He ordered an mp MRI which is scheduled for feb 18th. Will this test show if cancer is confined? I understand it had very good accuracy at detecting high grade cancer (4+) and can show how large and the location of the tumor. How doeS prostate volume come into play? My volume is 42 in size but not sure what that means other than that its size.

Also can the test give indicTion of wether nerves can be spared and If the tumor has escaped the gland?

Does it take special training by radiologist or urologist to read this report?

Thank you

newbie2pc
Posted Today 11:11 AM (GMT -5)
mpMRI is very useful when biopsy finds no cancer or G6 but PSA is high or rising, because it may confirm the need of further tests or treatment.
The data should be carefully examined by somebody with specific knowledge on this image technique who usually assigns a PIRADS grade. Therefore, your doctor does not need to have much knowledge on the technique to interpret the findings.
The "bad" PIRADS ratings, 4 or 5, indicate high probability of significant disease, already shown in your G4+3 core. PIRADS 5 is usually assigned for greater tumor volume or in the case of probable extension. Therefore, PIRADS 4 would not be a further bad news for your particular case, it just would confirm what the biopsy shows. Adding contrast helps to find if there is local or nodal extension. The location of the tumor is another valuable information from mpMRI that can help either the surgeon or radiologist to establish a more accurate plan for your treatment. Conventional biopsies are based in random cores and do not give a detailed information.
If I remeber well, it is necesary to wait some time to heal the prostate when you want to have a MRI test after the biopsy to avoid arfifact lesions. I suggest you to comment this poit to your doctors.
Posted Today 12:06 PM (GMT -5)
As I understand, the decision to spare nerves is made during the surgery based on what the surgeon sees and feels. The MRI would not be conclusive as it doesn’t really see the cancer as cancer and it can’t detect small clusters of cells that the surgeon may find suspicious. The MRI may provide a favorable indication, but the decision will be made by the surgeon during the surgery. And basically escape as well. the MRI may show an area that is suspicious and that might influence whether you use surgery. But if it doesn’t show a suspicious area that does not ensure no escape. Again the surgeon and then the pathology will make that determination. Sometimes escape is microscopic and can only be determined by positive margins found during the pathological study.

Basically the MRI is helpful and can provide direction but is has significant limitations as well.
Posted Today 5:12 PM (GMT -5)
A 3T mpMRI will detect nodules and tumors larger than 1 or 2 mm in size. But many prostate cancers are multifocal and low yield such as what I had. My 3T mpMRI and it didn't show any cancer. Yet the biopsy showed 7 of 13 cores with low yield cancer.
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