Is Prostate MRI Screening a viable alternative to ultrasound directed biopsies? I'm considering having this done as a screening much like a colonoscopy or mammogram. My PSA tends to be high and DRE's are normal. I just want some peace of mind. The latest Prostate MRI's are non-invasive and a tech who works at an imaging center said the cost after my deductible would be about $90.00.
Blackhawk
Member
They are two very different things which give different results.
3T MP MRI will show small tumor growth better than biopsy, but needs to be interpreted by sources very skilled in prostate MRI interpretation. There are apparently many MRI facilities that do bad work in house. Worth finding out... $90 for MRI sounds suspiciously cheap. I'd want to know what I am paying for.
Blind biopsy is shooting in the dark, ultrasound guided helps them get a good spread throughout the prostate gland, but can still can completely miss cancer. MRI guided is a better option for accurate biopsy of actual tumors found via MRI imaging.
With biopsy, if cancerous cells are found they can be examined. You get a Gleason score based on number/type of cancerous cell growth from biopsy. And the type of cells identified can be assessed for aggressive vs indolent cancer traits. You do not get this from MRI.
I have higher than desired PSA as well. In my own case, I'll be requesting 4K score test first, then if needed 3T MP MRI with proper interpretation before any biopsy.
3T MP MRI will show small tumor growth better than biopsy, but needs to be interpreted by sources very skilled in prostate MRI interpretation. There are apparently many MRI facilities that do bad work in house. Worth finding out... $90 for MRI sounds suspiciously cheap. I'd want to know what I am paying for.
Blind biopsy is shooting in the dark, ultrasound guided helps them get a good spread throughout the prostate gland, but can still can completely miss cancer. MRI guided is a better option for accurate biopsy of actual tumors found via MRI imaging.
With biopsy, if cancerous cells are found they can be examined. You get a Gleason score based on number/type of cancerous cell growth from biopsy. And the type of cells identified can be assessed for aggressive vs indolent cancer traits. You do not get this from MRI.
I have higher than desired PSA as well. In my own case, I'll be requesting 4K score test first, then if needed 3T MP MRI with proper interpretation before any biopsy.
Last edited:
DragonBits
Well-Known Member
I think the best non-invasive test is the PCA3 test. My urologist suggest this test, I am not sure if Medicare covers the cost or what the exact cost will be. So I said OK, let's do it, I have yet to get the result.
I think it's better than the 4k score test, though it does require a DRE and a urine sample immediately after the DRE.
No doubt medicare would cover a biopsy, which might make it cheaper for me personally, though I think less accurate.
===========================================
The prostate cancer antigen 3 (PCA3) test detects genetic material (messenger RNA (mRNA)) that is produced only by the prostate. The protein PCA3 and its associated mRNA are present at low levels in normal prostate tissue. PCA3 is present in increased amounts (over-expressed) in about 90% of prostate cancers. Prostate specific antigen (PSA) is also produced in increased amounts by prostate cancers but can be increased in a number of benign conditions as well.
This test measures PCA3 mRNA and PSA mRNA in the first urine sample collected following a digital rectal exam (DRE). Laboratories report a score based on the ratio of PCA3 mRNA to PSA mRNA called the PCA3 score.
PCA3 | Lab Tests Online
I think it's better than the 4k score test, though it does require a DRE and a urine sample immediately after the DRE.
No doubt medicare would cover a biopsy, which might make it cheaper for me personally, though I think less accurate.
===========================================
The prostate cancer antigen 3 (PCA3) test detects genetic material (messenger RNA (mRNA)) that is produced only by the prostate. The protein PCA3 and its associated mRNA are present at low levels in normal prostate tissue. PCA3 is present in increased amounts (over-expressed) in about 90% of prostate cancers. Prostate specific antigen (PSA) is also produced in increased amounts by prostate cancers but can be increased in a number of benign conditions as well.
This test measures PCA3 mRNA and PSA mRNA in the first urine sample collected following a digital rectal exam (DRE). Laboratories report a score based on the ratio of PCA3 mRNA to PSA mRNA called the PCA3 score.
PCA3 | Lab Tests Online
Blackhawk
Member
Looks like PCA3 is not first line testing, but followup to unremarkable biopsy to reassess doing more biopsy?
"it could be useful clinically for a patient for whom digital rectal examination and PSA suggest possible prostate cancer, but the first prostate biopsy returns a normal result. This occurs in approximately 60% of cases, and on repeat testing, 20-40% have an abnormal biopsy result."
de la Taille A (September 2007). "Progensa PCA3 test for prostate cancer detection". Expert Review of Molecular Diagnostics. 7 (5): 491–7. doi:10.1586/14737159.7.5.491. PMID 17892357.
"it could be useful clinically for a patient for whom digital rectal examination and PSA suggest possible prostate cancer, but the first prostate biopsy returns a normal result. This occurs in approximately 60% of cases, and on repeat testing, 20-40% have an abnormal biopsy result."
de la Taille A (September 2007). "Progensa PCA3 test for prostate cancer detection". Expert Review of Molecular Diagnostics. 7 (5): 491–7. doi:10.1586/14737159.7.5.491. PMID 17892357.
The tech told me $90 after Medicare and deductible. It sounded low to me also. I'm with Defy and anything over a 4 on the PSA and they want you to get checked. Mine was a 5.4. I'm usually a 4. I'll soon be 67. My NP wants me to retest in 3 months but I think I'll do it sooner. The MRI is a possibility I'm looking into.
I have some post on my PSA adventure.....
Do an "advanced search" for "PSA".
A number of post offer some good info.
FYI I hit a PSA of 8.1 over a short period and the culprit was a prostate infection.
BTW I am north of you age wise
My PSA shot up.
BIOPSY...BIOPSY.... BIOPSY... said the Uro....
4k first said I
3T MP MRI second said I...
As noted I had a prostate infection and had NO need for a blind biopsy at that point in time.
As noted above the 3T MP MRI is only as good as the DR that is reading it.
The 4Kscore Can Accurately Identify the Risk of Aggressive Prostate Cancer
You can go here and sign up and look around the PCa forum. A LOT of good info in PCa, treatment options and testing from folks that have already gone done that road.
Us TOO Prostate Cancer - Inspire
Also I think as we age the PSA tends to move up a bit also. I was hovering a little over 4 and recently it pushed up past 5 BUT I am also having kidney stone issues and a possible infection and both can impact testing.... OUCH!!!!
Do an "advanced search" for "PSA".
A number of post offer some good info.
FYI I hit a PSA of 8.1 over a short period and the culprit was a prostate infection.
BTW I am north of you age wise
My PSA shot up.
BIOPSY...BIOPSY.... BIOPSY... said the Uro....
4k first said I
3T MP MRI second said I...
As noted I had a prostate infection and had NO need for a blind biopsy at that point in time.
As noted above the 3T MP MRI is only as good as the DR that is reading it.
The 4Kscore Can Accurately Identify the Risk of Aggressive Prostate Cancer
You can go here and sign up and look around the PCa forum. A LOT of good info in PCa, treatment options and testing from folks that have already gone done that road.
Us TOO Prostate Cancer - Inspire
Also I think as we age the PSA tends to move up a bit also. I was hovering a little over 4 and recently it pushed up past 5 BUT I am also having kidney stone issues and a possible infection and both can impact testing.... OUCH!!!!
what was the rate of rise of his PSA?
Are you talking about a blind biopsy?
Has a prostate infection been ruled out?
The 4K test is a blood test.
I have posted a copy of my test results so folks can see what it looks like.
Do a search for 4k blood test and see if you can find it.
The MRI is done with a 3T that is a newer more powerful MRI.
Where does you Dad live?
Might make sense to find a location near by in a bigger city and get one done.
I suggest going to here:
Us TOO Prostate Cancer - Inspire
and look at the post that cover 3T MP MRI and see if any of the locations mentioned are close enough to your Dad to make a short trip, if you decide to go that route.
Blind biopsy can miss stuff.
The 3T MP MRI will identify specific areas of concern that can be targeted for biopsy.
A lot of pieces to this puzzle....
Are you talking about a blind biopsy?
Has a prostate infection been ruled out?
The 4K test is a blood test.
I have posted a copy of my test results so folks can see what it looks like.
Do a search for 4k blood test and see if you can find it.
The MRI is done with a 3T that is a newer more powerful MRI.
Where does you Dad live?
Might make sense to find a location near by in a bigger city and get one done.
I suggest going to here:
Us TOO Prostate Cancer - Inspire
and look at the post that cover 3T MP MRI and see if any of the locations mentioned are close enough to your Dad to make a short trip, if you decide to go that route.
Blind biopsy can miss stuff.
The 3T MP MRI will identify specific areas of concern that can be targeted for biopsy.
A lot of pieces to this puzzle....
DragonBits
Well-Known Member
MY MISTAKE:
The test I took and was thinking of is SelectMDX
The test I took is done very similar to PCA3, the prostate is massaged and urine is collected immediately afterwards. So you need to do this in an urologist office.
SelectMDX has a 98% negative predictability for prostate cancer. In in others words, it only has a 2% chance of missing prostate cancer.
You can see here the various tests and how accurate they are at predicting possible prostate cancer.
Overview diagnostic biomarkers
The report I got looked exactly like the second report in this link. It said:
The SelectMDX test result for this patient indicates a very low risk for the detection of Gleason score >= 7 prostate biopsy with a negative predictive value of 98%, and a negative predictive value of 99% for Gleason score >= 8 or prostate cancer.
http://www.pcmarkers.com/selectmdx-results
Basically, this is a test telling the urologist whether they should to a biopsy or not. In my case, it proves there was very little reason to do a biopsy.
Careful with PCA-3. Memorial Sloan Kettering, Lenox Hill, Cornell, and Mt Sinai here in NYC have all stop using it do to a high flase positive rate. It for the most part has been replaced by 4K
No way is it first line testing. And it is falling out of favor. see my response below
Multiparametric MRI are tricky to read. Get one in a high volume facility. Also, at this point in time the ability of the radiologists reading them is highly variable. I spoke to Dan Margolis just this morning about this ironically. He probably has read more than anyone in the country. Formally from UCLA now at Cornell. Also, you must use a 3T machine
The nice thing about this test is its negative predictive value is 90%
That’s an impossible question to answer. PSA Has been around for 30 years and people are still arguing over that
However, what I like about select MDx is that it is an entirely different test altogether
Did I you know that the 4K score incorporates 3 derivatives of PSA and another related compound. It also adds clinical data that you already know like your age race and family history
Select mdx is completely different. So I can see select mdx plus PSA being more valuable than 4K plus PSA.
However, what I like about select MDx is that it is an entirely different test altogether
Did I you know that the 4K score incorporates 3 derivatives of PSA and another related compound. It also adds clinical data that you already know like your age race and family history
Select mdx is completely different. So I can see select mdx plus PSA being more valuable than 4K plus PSA.
DragonBits
Well-Known Member
I agree, I misposted.
It was the select MDx that I was thinking of and iI think it's the best if your PSA goes up too much. In fact, I think it's better than a biopsy in that a biopsy can easily miss cancer.
I got it because my PSA went to 4.2, I wasn't worried but Defy and my urologist were worried, so I got that to make them feel better. As I thought, very low risk.
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