I’m reading a book about Edison suing Westinghouse in the late nineteenth century and the development of alternating current. The Serbian who “conquered” alternating current was a idiosyncratic man named Nikola Tesla. It is very interesting however I am in love with the nineteenth century and the men and women of history of that era. Think Twain, Edwin Booth, Henry James, Grant, Kipling, Osler, Roebling, Carnegie, Frick, etc and etc.
So about the study that follows and there are a lot like them. The advent of the MRI for the prostate and what does it mean, does it help, is it really that much better than systematic ultrasound guided biopsies considering the cost and time element.
In a time of all the talk of cost, why is there not more condemnation of the cost of the MRI and the interpretation of it by the radiologist by our “experts.”
Anyway here is the article. Keep in mind I have done thousands of prostate biopsies in my career and the expense of the procedure, the ultrasound, the materials used and what is paid to me for doing is less expensive than an MRI alone. Where is the outrage?
Poor little ole PSA. The Rodney Dangerfield of Medicine. Are the letters MRI more sexually appealing than the letters PSA. Oh by the way…why do you order a MRI in the first place? You guessed it…an elevated PSA…that dirty rascal keeps popping his knarly little ole head…don’t he?
Feel free to opine…if you are well versed in the MRI movement, the benefits, the cost, and why it should be the only study done on men suspected of prostate cancer please…comment. I truly want to be enlightened. Predict the future.
Prostate MRI in the Prebiopsy Setting
Urology – June 15, 2016 – Vol. 34 – No. 3
Prostate MRI in the prebiopsy setting may help identify Gleason 7 and higher cancers.
Article Reviewed: Prebiopsy MRI and MRI-Ultrasound Fusion-Targeted Prostate Biopsy in Men With Previous Negative Biopsies: Impact on Repeat Biopsy Strategies. Mendhiratta N, Meng X, et al: Urology; 2015;86 (December): 1192-1198.
Background: Prostate MRI has seen an explosion of use over the past 5 years. The perceived benefit of prostate MRI is in the identification of high-grade disease and thereby decreasing the overdetection of clinically insignificant prostate cancers.
Participants: Patients presenting to a single institution with elevated prostate-specific antigen (PSA) levels.
Methods: Patients underwent multiparametric prostate MRI with a 3 Tesla unit. Prostate lesions were scored on a scale of 1 to 5, with 5 being very high probability of cancer. Patients with target lesions underwent targeted biopsy with a standard 12-core template biopsy. Patients with a normal MRI were not included in the study, as targeted biopsy could not be performed.
Results: 352 patients were included in the study. Prostate cancer was identified in 207 men. Cancer detection rate was higher in the standard template group (49.2%) than in the targeted biopsy group (43.5%). However, targeted biopsies detected more Gleason 7 or greater disease (88.6%) compared to the standard template (77.3%). Higher volumes of clinically insignificant prostate cancers were detected by standard biopsies. Using suspicion level of 4 and 5, 85.9% of patients were found to have prostate cancer, with 69.1% having Gleason 7 or higher. Using suspicion level 4 and 5, sensitivity, specificity, and negative and positive predictive value were 78.0%, 81.6%, 87.6% and 69.1%, respectively, for finding Gleason 7 or greater disease.
Conclusions: For men with elevated PSA levels, multiparametric MRI is a valuable tool in the prebiopsy setting for detecting clinically significant disease.
Reviewer’s Comments: The authors present compelling data for the addition of MRI in the prebiopsy setting for patients with elevated PSA. What is not included in the study are the data for those patients with negative prostate MRI. In addition, MRI is an expensive imaging modality. Does improved detection of Gleason 7 prostate cancers justify the cost on a population level?(Reviewer–Michael Poch, MD).
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I don’t know why this isn’t the most popular blog on the Internet. I am the wife of a man who is still struggling through a possibly misguided diagnostic phase. When I started learning about the prostate, I became fairly fascinated by it. I now read whatever I can on chronic prostatitis and PC. It is interesting to me, not just because my husband is struggling with prostate issues.
Anyway, thank you.
I wonder why our urologist has not taken this study to heart. It was published in an easily-accessible journal. My hubby has a PSA of between 24 and 29. Urologist has done 2 long rounds of abx, lasting a total of two and a half months. PSA went down from its average of 25, to 20 for one week, then was back up. Although I know this could still be chronic prostatitis, however, as my hubby’s father has PC, and two different urologists have appreciated a very firm area in DRE, I suspect it is cancer. My husband’so other symptoms are back pain , fatigue, and he had blood in his urine (which could also be prostatitis).
I asked two urologists about fusion biopsy, thinking that we will be dealing with a Gleason of 7 or higher….nothing. Got a couple of different excuses. One guy…a young board-eligible guy, said the technology isn’t there yet, and he could refer me out to someone who does it, if he can find someone (we are in a huge metro area). Our original urologist, very seasoned, says the test is worthless. It doesn’t sound worthless in this study.
My problem is that I have lost a tad bit of faith in our urologist…one for waiting so long when hubby could have an aggressive cancer – he is only 53 – and another for saying mri-guided biopsy is bunk.
I’m afraid the random biopsy will miss an aggressive cancer. I suppose it is good that he appreciated a hard area, for he can at least target that. I also understand that he did not want to biopsy an infected prostate, but it seems like that would be an instance where one might use an MRI instead of waiting 3 months from first VERY HIGH PSA to biopsy.
How long does it take a technological advancement to ‘take’ and become standard of care in your field?
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