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I am writing on this subject at this time because of Terry's response to Peet concerning MRIs. I, too, understood from my research that MRIs are capable of identifying large tumors that may be aggressive, and that small tumors may be missed, with the belief being that these smaller lesions are likely to never pose a threat. My own experience somewhat matches that assessment of an MRIs capabilities, but it also includes a misdiagnosis by the radiologist that reviewed the scan. I was quite surprised and disappointed by this, especially since MGH was just recently rated as the number one hospital in the United States, surpassing Johns Hopkins.
What happened was this. I knew from an earlier CDU/targeted biopsy (performed by Dr. Bahn) that I had a rather large 11 mm lesion that showed up on the ultrasound, and a much smaller lesion (5% of the core) discovered near the left neurovascular bundle by the needle biopsy, which the scan missed. My subsequent MRI also identified the large lesion, measuring it at 13 mm, but like the CDU, it was not able to detect the smaller tumor.
The misdiagnosis involved the fact that the radiologist’s written report did not identify the lesion as cancer because it didn't (and I quote) "demonstrate restricted diffusion or enhancement". He went on to say that the lesion probably represents a bone island. I guess you could call this a false negative, which is not uncommon as Terry pointed out. My surprise and disappointment comes from the fact that the records of three TRUS and one CDU/targeted biopsy were sent to the hospital for review and they all clearly showed that I had cancer. In fact, inexplicably, the earlier cancer diagnosis was right there in the summary report sent to me by MGH, only a few lines about the doctor's diagnosis. The irony is that the hospital promotes with pride the fact that all MRI scans are evaluated by a radiologist.
So, I decided to share this with the readers to highlight the mistakes that can be made by not only the machines, but also the doctors, including those that work at the highest rated hospital in the United States. AN EXCELLENT REASON TO GET A SECOND OPINION IF EVER THERE WAS ONE.
P.S. One last note. Even though, as mentioned above, smaller undetected tumors are believed to pose no threat, that is not always the case. For example, prior to the biopsy results, Dr. Bahn said that he was in favor of my continuing on active surveillance, and added that he doesn't say that very often. However, with the discovery of the small tumor near my left neurovascular bundle, he raised my clinical stage and was, at best, on the fence about my AS choice. The reason he gave me for his change of position was that he was uncomfortable with the finding of the tumor near the neurovascular bundle since it is a common pathway out of the gland. For the record, though, I am still on AS despite the findings because Dr. Bahn agreed with previous assessments that I am a Gleason 6, and as Dr. Myers stated in one of his videos, if Dr. Bahn finds you to be a Gleason 6, then the chances of you having a higher Gleason score is low.
