a different take on the mri-spectroscopy for prostate cancer- and other sundry thoughts and usage of this modality

waste is a terrible thing to mind

Yes that is Jolly Time Pop Corn that I get on the way to the Chattahoochee River at a small community IGA store. Ever been to one…it’s a vestige of the past and a joy to shop in. Most of the products are from companies you would not recognize. I can chicken there $1.50 a lb. cheaper than Krogers in Gainesville and this Jolly Time Pop Corn is just as good as name brands at half the cost. Chloe loves chips and pop corn….Penelope won’t eat that stuff…now she’ll kill Alpo-Chunky with Rice….mmmmmmmm.

Her tired from chasing sticks in the river!

  • MRI-S can identify the neurovascular bundle’s involvement with prostate cancer and that might change the surgeon’s approach/aggressiveness or knowing this may incline the radiotherapist to use seeds and external beam radiation.
  • Knowing the extent of local disease may preclude the use of the newer modalities that are currently treating the mild to mod favorable cancers…i.e. a guy planning Proton therapy has the MRI-S and determines his disease is less favorable or more extensive than thought on biopsy may decide to take a more aggressive approach to his treatment.
  • It appears that this test is best suited “after” the biopsy has been done. The the study mentions that the biopsy and resultant bleeding can “mess up” the reading.
  • If one is doing this because the PSA is elevated and he wants to get out of doing a biopsy…well this doesn’t appear to be a 100% way out. The report concludes that maybe if the MRI-S is negative then maybe the disease if present is so clinically insignificant that it doesn’t need to be treated.  Does that help you?
  • MRI-S could be used for patients choosing surveillance. Right now I do a PSA twice a year and repeat a biopsy yearly (John Hopkins protocol). I guess if the MRI-S was really good, following that study instead of a biopsy might be reasonable.
  • Finally…the reason I chose this subject (MRI-S) is because I met a patient who wanted it done before he had a biopsy. I initially felt he wanted it done to “get out of” a biopsy. That was not the case at all…now follow this…he wanted to be sure that if his prostate biopsy was negative that the negative result was for real. In other words he was concerned that one could have a negative biopsy and still harbor an aggressive cancer that was missed because the urologist only takes 12 small samples and that something could be missed. (He was not looking for a reason not to have a biopsy, which is the most common scenario, rather he wanted assurance that the biopsy was reliable if negative. Our hospital did not have the MRI coil to do this. We are checking into whether his insurance will cover the study in the Atlanta area…developing.
  • As Shultz said on Hogan Hero’s…”Verdy interesting.”

“Although the inability of endoMRI/MRSI to consistently identify low-volume or low-grade cancers may be seen as a limitation of the technique, such cancers are likely to have a long natural history even without treatment, so failure to detect and treat them may have little impact on cancer-specific morbidity and/or mortality.”

Everything in the world you’d ever want to know about MRI Spectroscopy

2 Replies to “a different take on the mri-spectroscopy for prostate cancer- and other sundry thoughts and usage of this modality”

  1. Dr. McHugh,
    I continue to to do research on utility of prostate imaging. I attach links that support potentialially supports use in 3 scenarios.
    1. High PSA and patient just adamantly opposed to biopsy. Having imaging results showing signal for PCa will give them the courage. The imagining modalities discussed in attached articles are not all available in Gainesville/Atlanta area, but a some are. Some patients might be willing to travel. You sent me to Emory, pre-biopsy, and they saw enough to get me back to you for biopsy. My only regret was being there on a Monday when Tuesdays are actually propofol days. But honestly, the Versed is plenty. Your technique is little more than just uncomfortable. Also, taking it like a man increased my self esteem.
    2. Patients who have negative biopsy and persistently high PSA. Personally, I was OK with one biopsy. I was releived when it was positive. Gleason 6. Confirmed at Johns Hopkins, PSA never greater than 10; low grade cancer. Active Surveillence is on the list of options. I must admit that sometimes I wish it had been a 7, eliminating AS and sending me straight to RARP. I hate making decisions and this is a big one. Given low grade and no metastacies, I am choosing AS. I was thrown a curve ball wHen first PSA after biopsy was 35.
    Fearing metastasis, you did a Prostatic Acid Phosphotase that was low and indicated very low potential that metastasis had occurred. A follow up with CT/bone scan confirm no mets. I now proceed with AS. But AS with modified protocol. In addition to DRE and PSA, I hope to employ multiparparametric imaging as described in attached article. I will have to travel as this technology somehow challenges imagining facilities in Atlanta area, even Emory. Centers that I know this technology is available are UF Jacksonville, John Hopkins, UCSF (could turn into wine tasting trip), UCLA. There are many more; I just have had time to find them all.
    3. Staging the disease.



    Click to access 687.full.pdf

    Click to access AR_01-02-09_Futterer.pdf



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