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

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