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FYI: A Warning about Misinformation on an MRI following a Biopsy
I had a CDU/targeted seven core biopsy on February 29th and wanted to follow that up with an MRI (with an endorectal coil). I wasn't sure whether or not I needed to wait on the MRI until my prostate had a chance to heal from the biopsy. To be absolutely sure that I did not schedule the appointment too soon, I called three major medical/cancer centers in the Boston area and talked to technicians in their MRI departments. Each one of them said that I could go ahead and make the appointment because the MRI would be unaffected by the biopsy. Therefore, I made the appointment on March 28th at Beth Israel Deaconess Medical Center in Boston (since they had the most up-to-date equipment, namely a 3.0 Tesla machine). When I got the results a week later, I found that the scans were unreadable due to the fact that my prostate was still hemorrhaging from the biopsy. I was upset and disappointed to say the least.
The insight that the MRI was supposed to give me was to be an important part of my decision-making process that involved staying on AS or seeking treatment. More specifically, I have a small tumor (5% of the biopsy core) right up against, but not outside of the capsule near the left neurovascular bundle that did not show up on the CDU scan, but was instead discovered during the biopsy. Because the neurovascular bundle is a common pathway out of the gland, I was keenly interested in seeing whether or not this tumor showed up on the MRI since, it is my understanding, that the scan tends to miss insignificant tumors and pick up those that are possibly aggressive. Also, the MRI is supposed to be capable of detecting extraprostatic extension, which is something the CDU did not find evidence of. (However, the Dr. (Bahn out of Ventura, CA) did say that he could not be sure of the findings).
For the record, I'm still planning to get an MRI, first by trying to get into a clinical trial at Memorial Sloan Kettering, and if I fail to be accepted, my second and only remaining option will be to wait until my insurance company is willing to pay for another procedure (which, I would imagine, would be six months from the last one). I say this because the out-of-pocket expense for an MRI would be approximately $4000, which is not at all close to being in my budget. In closing, I have to say that the cost aspect of this bad experience really bothers me as well. In other words, what if I had paid for the MRI out of my own pocket? I would be out $4000 because the hospital certainly does not give refunds for giving bad advice. So, my advice to those reading this that may possibly be faced with similar circumstances, is to give your prostate plenty of chance to heal after a biopsy before scheduling that MRI, despite what the hospital has to say.
Re: FYI: A Warning about Misinformation on an MRI following a Biopsy
Alan, I had my MRI (with an endorectal coil) at M.D.Anderson and they would not do the MRI until 6 weeks after my biopsy date. Hope you will be able to get another one. I wanted it sooner but glad they made me wait after reading your experience.
Re: FYI: A Warning about Misinformation on an MRI following a Biopsy
Alan,
I was wondering why you wanted to get the MRI after the biopsy rather than before. In my case I was on AS for 3 years and my PSA kept rising. My uro's non-targeted biospies sometimes found very small GS6 or at other times nothing at all. I asked about a CDU or MRI and he gave them no credibility at all. Luckily our local cancer center installed a new MRI program (non-coil) called VividLook. I had the MRI done and using those images a new uro found a GS8 tumor for which I sought treatment. I wanted the MRI done prior to the biopsy since I suspected my tumor might have been in a place difficult to access. (It wasn't--my old uro was a bad shot I guess)
Re: FYI: A Warning about Misinformation on an MRI following a Biopsy
Joe,
If I am interpreting your post correctly, you had an MRI guided biopsy where your Gleason 8 tumor was detected and then biopsied in the same procedure. Essentially, I had a similar "targeted" biopsy done, except that it was done with the aid of a CDU scan designed to show the location of the tumor or tumors. Dr. Bahn then used this scan to inject a biopsy needle into the heart of the tumor that he did find in order to be able to better determine its true Gleason grade. I also had him biopsy other areas even though no tumor was visible on the scan in those places. Of particular interest to me was the area of the prostate near the left neurovascular bundle and left seminal vesicle since they are common pathways out of the gland. As I said in my post, the biopsy did pick up a small tumor that the scan missed which is right up against, but not outside of the capsule in the area of the left neurovascular bundle.
So, it seems to me Joe that we both had a scan and biopsy in the same procedure, with the only difference being that I scheduled an additional scan (meaning the MRI) after. The inability to read the MRI results was simply due to scheduling the appointment too close to the biopsy based upon bad advice from three different hospitals. I was in no hurry after the biopsy to schedule that appointment. If even one of the three hospitals had advised me to wait a certain number weeks for my prostate to heal, I certainly would have done that. In fact, I am the type of guy who would take into account the number of weeks I was told to wait and tack on a couple of more just to be on the safe side. However, as you know from reading my post, all three hospitals said that no waiting period was necessary. At the time, since it came from three different sources, there was no reason to believe that they were wrong. Since I did not want others to go through the same experience, I posted my warning.
I hope I have answered your question Joe. Feel free to write me back if I did not.
Re: FYI: A Warning about Misinformation on an MRI following a Biopsy
Alan,
Thanks for the clarification. Actually, mine was a bit different. I was planning to fly out to CA (I live in NC) and get a targeted biopsy from Dr Bahn, when I found out that my local hospital had a new MRI that was supposed to be able to spot PCa tumors. The MRI and biopsy were not done at the same procedure. The MRI was done first and created a CD containing a series of scans which clearly showed the tumor. Using these pictures as a guide, my new uro was able to put 6 cores into a small 1cc tumor. My biopsy was "targeted" but not "real-time" targeted like Dr Bahn and his CDU.
Re: FYI: A Warning about Misinformation on an MRI following a Biopsy
Alan,
I would go back to the doctor/department who gave you the MRI & demand a second MRI at no cost because the first scans are unuseable.
I feel that your case would be stronger if you remember who said that it's OK to have the MRI
and if the radiologist had in your file the date of your biopsy and yet still went ahead & gave you the MRI. If they won't refund your complete $4000,
maybe they'll give you a 50% reduction.
Doug
Re: FYI: A Warning about Misinformation on an MRI following a Biopsy
Hi Doug,
Thanks for the advice, which I'm going to follow through on. I found this passage on the following website which I am going to use as the basis of my argument: www.radiologyinfo.org/en/info.cfm?pg=mr_prostate
"MRI cannot always distinguish between cancer tissue and inflammation or presence of blood products within the prostate, which sometimes occurs related to a prostate biopsy. To avoid confusing the latter with the former on imaging, prostate MRI should be performed more than six to eight weeks after prostate biopsy, if possible, to allow remnants of bleeding to resolve."
If I fail, it won't be for lack of trying (and, at the very least, I'll still be thankful that the cost did not come out of my own pocket). Wish me luck.
