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If you have had a MRI would you comment for me on how much it cost…both the procedure and the radiologist reading it. Don’t get me wrong. I think the MRI will be very helpful for all…but weren’t we just talking about costs of psa, biopsies, treatment, etc and etc. Where is the outrage? USPSTF where are you? Issue a statement and recommendations regarding the use and payment of the MRI. You picked on Mr. Psa but is Mr. MRI too big a boy for you? You talked about the “risk” of having a Psa drawn…now let’s hear about the “risk” of having an MRI…you know…the expense and inconvenience of the MRI, the finding of a “spot” but the spot when biopsied, oh yes that terrible biopsy, but the spot has no cancer because the spot was a false positive, and oh yes the patient became septic because of the biopsy and had to be admitted to the hospital and etc and etc. Someone please…speak out about the risks of an MRI. As they say, “the silence is…deafening.”

Ps…I’ll find out the cost of a prostate MRI and the cost of reading it and I’ll compare that to the cost of a Psa, urologist office visit, prostate biopsy, and the reading of it by a pathologist-all combined and I’ll wager that the latter is much cheaper than the former. Have you read anything about the costs of an MRI? HmmmmmmmInvestigative report by pepe the prostate

Do you have a “naive” prostate?

 

Pts Who Are Biopsy Naive Can Benefit From Prostate MRI

Urology – May 30, 2016 – Vol. 34 – No. 2

Prostate MRI improved the detection of significant prostate cancer in patients undergoing initial prostate biopsy.

Article Reviewed: Presence of MRI Suspicious Lesion Predicts Gleason 7 or Greater Prostate Cancer in Biopsy Naïve Patients. Weaver JK, Kim EH, et al: Urology; 2016;88 (February): 119-124.

Background: The use of MRI has become more common in patients considering prostate biopsy after a prior negative biopsy. However, for patients who are biopsy naïve, the role of MRI has not been established.

Objective: To conduct a study of patients undergoing prostate MRI prior to prostate biopsy.

Design: Single-institution retrospective study of the records of 100 patients undergoing prostate biopsy after MRI at Washington University, St. Louis, Missouri, between 2012 and 2014.

Methods: The study evaluated prostate MRI and other factors to identify predictors of Gleason ≥7 prostate cancer (G7+) on prostate biopsy. Patients with MRI-suspicious regions (MSRs) underwent cognitively targeted biopsy. Those without MSRs underwent a 48-core template biopsy.

Results: On multivariate analysis of biopsy-naïve patients, presence of MSR was the only significant predictor of G7+. However, for patients with prior negative biopsy, MSR was not a predictor. PSA density >0.15 was predictive of G7+.

Conclusions: Patients who are biopsy naïve can benefit from prostate MRI if a MSR is identified that can be used to guide prostate biopsy.

Reviewer’s Comments: The use of MRI and guided biopsy has become increasingly common. Several studies have shown an increased detection rate of significant cancer in these patients. However, the use of prostate MRI in biopsy naïve patients is less well studied. This was a retrospective study evaluating prostate MRI in men undergoing prostate biopsy at Washington University in St. Louis, Missouri. All patients underwent an extended template biopsy (48 cores), but patients with an MSR underwent cognitive fusion biopsy with 4 to 6 directed cores. Multivariate analysis was conducted to identify factors associated with G7+. Patients were evaluated as biopsy naïve or prior negative biopsy. For patients who were biopsy naïve, presence of MSR was the only significant predictor of G7+ on biopsy. However, for patients with a prior negative biopsy, only PSA density was predictive of G7+. Prostate MRI and fusion biopsy have become increasingly utilized in patients with a prior history of negative biopsy and those undergoing active surveillance. However, use of prostate MRI in patients who are biopsy naïve is less well known. The potential cost implications could be prohibitive. However, improved detection may ultimately benefit patients. In this study, prostate MRI improved G7+ detection in biopsy-naïve patients but not patients with a prior negative biopsy.(Reviewer–Kelly L. Stratton, MD).

 

Author: Weaver JK, Kim EH, et al
Author Email:  uropro2012@gmail.com

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