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Prostate MRI Tomorrow

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User
Posted 24 Jun 2019 at 20:46

I’m 54 and my PSA level was 3.8 in April 2018. On 16th May 2019 I had a routine blood test having moved to a new home and new GP Practice. The result of this blood test showed a PSA of 7.5. Rightly my GP did a second blood test to weeks later and my PSA level on that occasion came back at 8.3.

Anyway, on Thursday last week I saw a consultant urologist and he referred me for an urgent MRI which is to take place tomorrow (Tuesday 25th June 2019). This is great, but the appointment has come so fast I haven’t even received a letter explaining exactly what the procedure entails. With this in mind any information would be very much appreciated.

 

User
Posted 24 Jun 2019 at 22:29
Piece of cake, Kevin. You’ll get undressed to your underwear and put on a hospital gown. Then you lie on a moveable table which will pull you inside the MRI scanner, which is a hollow cylinder with you in the middle. It’ll move you backwards and forwards for maybe 20 minutes to scan different bits of you, and that’s it. It’s EXTREMELY noisy, so you’ll wear headphones both to protect your ears and so you can hear instructions from the radiographer operating the scanner (the operator may ask you to hold your breath at times, for example). You won’t feel anything at all. It’s a little claustrophobic, but that’s as bad as it gets.

You’ll get an appointment to find out the results maybe two weeks after the scan.

Hope that helps,

Chris

User
Posted 24 Jun 2019 at 22:34

Kevin

If I remember correctly, my scan took about 45 minutes to an hour.  The biggest challenge was lying absolutely still for that time.  I also had a dye injected into me near the end of the scan.  I was told it may feel cold and may make me feel sick, but I was fine.  It really is a straightforward process.  I think the MRI scan is the one where you can't have anything metal on you, hence the word magnetic.

Ask if it is a multi-parametric MRI scan.  That's the better type of scan.  If it is, you get a PIRAD score.  This is a score which goes from 1-5.  Unfortunately, mine was 5, meaning that clinically significant cancer was highly likely to be found on biopsy.

By having the scan before biopsy, the doctors will know where to biopsy thus increasing the chance of an accurate diagnosis.  It is only with a scan and biopsy that they can really tell if you've got cancer or not, but the mpMRI PIRAD score gives an indication.

The speed with which things are done can be a bit overwhelming.  Hopefully, you'll come back clear.

The specialist nurses here are brilliant.  Give them a call if you've got questions.

Ulsterman

 

 

User
Posted 25 Jun 2019 at 00:04

hi Kevin.

have a look at my profile.  includes me and my brother.

I never knew about pirad.   

I was always well informed of what was expected, albeit being very fit/healthy  had experienced hospital  environment only as a visitor. 

're.  scan what surprised me was the movement/vibration  of the 'bed' I was laying on. I had no idea if this was normal.  noise was expected.     there's folk always monitoring and there was a 'call' button on my machine...    I assume  some folk become claustrophobic.    duration of scan will depend on model/type  .    I think I nodded off.    

all the very  best.. 

Gordon 

User
Posted 25 Jun 2019 at 08:01

Kevin

 An interesting observation!  I am a mad keen cyclist and before my diagnosis early last year I was covering regularly over 200 miles a week. I had the transperineal template biopsy which is taken between the back of the scrotum and your anus, I had 32 biopsy needles taken and it does leave this area a bit tender but I was back on my bike within 2 weeks.  I had my first hormone therapy injection mid mid April 2018 and my  20 fractions of radiotherapy in August  and I have been on hormone therapy up to today. The point I would make is that I asked my oncologist about sport and everyone I spoke to stress the importance of keeping active and continuing your sport or activity  during PCa treatment.  I followed this advice and although the hormone therapy and radiotherapy has affected my fitness level and muscle tone I still manage an average of 90 to 100 miles a week albeit at a much reduced effort level as I tire very easily. But my point would be if you are a keen cyclist like me do not give up it has helped me immensely both getting over the treatment  and mentally 

Edited by member 25 Jun 2019 at 08:03  | Reason: Not specified

User
Posted 25 Jun 2019 at 14:21

Originally Posted by: Online Community Member
Can I ask what saddle you’re riding on?

An obsolete Specialized one.
Looks a bit like a Specialized Avartar Comp Gel Saddle 2016., but top surface is smooth leather.

It doesn't work well tilted forward - I tend to slide down it. I need to look for something else.

User
Posted 25 Jun 2019 at 15:05
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User
Posted 24 Jun 2019 at 22:29
Piece of cake, Kevin. You’ll get undressed to your underwear and put on a hospital gown. Then you lie on a moveable table which will pull you inside the MRI scanner, which is a hollow cylinder with you in the middle. It’ll move you backwards and forwards for maybe 20 minutes to scan different bits of you, and that’s it. It’s EXTREMELY noisy, so you’ll wear headphones both to protect your ears and so you can hear instructions from the radiographer operating the scanner (the operator may ask you to hold your breath at times, for example). You won’t feel anything at all. It’s a little claustrophobic, but that’s as bad as it gets.

You’ll get an appointment to find out the results maybe two weeks after the scan.

Hope that helps,

Chris

User
Posted 24 Jun 2019 at 22:34

Kevin

If I remember correctly, my scan took about 45 minutes to an hour.  The biggest challenge was lying absolutely still for that time.  I also had a dye injected into me near the end of the scan.  I was told it may feel cold and may make me feel sick, but I was fine.  It really is a straightforward process.  I think the MRI scan is the one where you can't have anything metal on you, hence the word magnetic.

Ask if it is a multi-parametric MRI scan.  That's the better type of scan.  If it is, you get a PIRAD score.  This is a score which goes from 1-5.  Unfortunately, mine was 5, meaning that clinically significant cancer was highly likely to be found on biopsy.

By having the scan before biopsy, the doctors will know where to biopsy thus increasing the chance of an accurate diagnosis.  It is only with a scan and biopsy that they can really tell if you've got cancer or not, but the mpMRI PIRAD score gives an indication.

The speed with which things are done can be a bit overwhelming.  Hopefully, you'll come back clear.

The specialist nurses here are brilliant.  Give them a call if you've got questions.

Ulsterman

 

 

User
Posted 24 Jun 2019 at 23:01

Thank you both for your replies they are most reassuring!
I did not mention in my original post that my father’s brother had his prostate removed as a result of his PC diagnosis about three years ago and it is as a result this I feel somewhat anxious.
That said, I am taking consolation in the fact that I had a CT Utogram in September 2018, and a cystoscopy in January 2019 which I assume would have picked anything sinister up. Certainly the consultant said the DRE showed my prostate to be smooth and soft though rather large.

Edited by member 24 Jun 2019 at 23:03  | Reason: Not specified

User
Posted 25 Jun 2019 at 00:04

hi Kevin.

have a look at my profile.  includes me and my brother.

I never knew about pirad.   

I was always well informed of what was expected, albeit being very fit/healthy  had experienced hospital  environment only as a visitor. 

're.  scan what surprised me was the movement/vibration  of the 'bed' I was laying on. I had no idea if this was normal.  noise was expected.     there's folk always monitoring and there was a 'call' button on my machine...    I assume  some folk become claustrophobic.    duration of scan will depend on model/type  .    I think I nodded off.    

all the very  best.. 

Gordon 

User
Posted 25 Jun 2019 at 01:40

I was told to come in clothes with no metal, such as a track suit (make sure no metal zip, eyelets, or bootlace ferules). I came in a T-shirt and rugby shorts, and kept my own clothes on. No restriction on eating or drinking beforehand, but you should go for a pee beforehand so you don't need to whilst in the machine.

As others said, about 40 mins, or faster in a 3 Tesla machine.

It will probably be a mpMRI (multi-parametric MRI scan). In this case you may get a gadolinium-based contrast agent (GBCA) injected near the end of the scan. (There are other ways to do a mpMRI, but this is common.) You will be asked lots of questions about any metal you might have in your body, and if you are having a GBCA, also about your kidney function. I have also seen instructions which say to stop taking Metformin for a couple of days when having a scan with contrast, because both put a load on the kidneys, although I didn't get any such instructions.

If you are interested, you can get your images. In many hospitals, this is done through Patient Services (PALS) - the radiographer will tell you.

Edited by member 25 Jun 2019 at 01:41  | Reason: Not specified

User
Posted 25 Jun 2019 at 07:43

Thanks Andy

It’s so helpful being able to read other people’s journeys, and in particular yours as it includes your brother’s story. I say this because I am an identical twin and he too shares similar symptoms to myself. Needless to say he is anxious about the outcome of my investigations as it could indicate that he is at risk should they come back positive.

On a personal note, it’s already been a few tough years medically. I started producing large ureteric kidney stones back in 2009 (2 cm in diameter) and have never been clear of stones since. In 2015 I was rushed in for emergency open surgery to remove an acutely gangrenous gallbladder, April 2018 investigated for urinary bleeding (hence CT urogram and cystoscopy), October 2019 minor hear attack despite cycling 150 miles per week, January 2019 another open surgery to remove what I was told was a large gallbladder and stones (consultant told me he didn’t know what the first surgeon had removed but that he had removed my GB), February 2019 lithotripsy for yet more kidney stones (a pretty regular occurrence), and now this.

Edited by member 25 Jun 2019 at 07:50  | Reason: Not specified

User
Posted 25 Jun 2019 at 07:48

Kevin

MRI is the first stage of the journey, usually after a DRE.  I sincerely wish you all the best today at your scan.  In the early stages of diagnosis in my opinion the worst part is waiting for results but just try to keep calm.  As your PSA is climbing rapidly it is not likely to be best of news for you. If the indications of the scan show that you have lesions,  The next logical step would be to take biopsies to discover what your Gleason staging is.  Different health trusts have different methods but I understand that Transperineal Template Biopsy is more than likely to be what you will get and in any case it is more accurate than the TRUS system, which can cause infection due to the method of puncturing the rectum wall. It will be another couple of weeks before you get the results of your biopsy is then you will have your Gleason score and grade and from there we can offer you much more information and advice

User
Posted 25 Jun 2019 at 07:54

Thanks for your best wishes.

I note you’re on your bike in your photo. I would hate not being able to ride mine should investigations turn out to be positive. 

User
Posted 25 Jun 2019 at 08:01

Kevin

 An interesting observation!  I am a mad keen cyclist and before my diagnosis early last year I was covering regularly over 200 miles a week. I had the transperineal template biopsy which is taken between the back of the scrotum and your anus, I had 32 biopsy needles taken and it does leave this area a bit tender but I was back on my bike within 2 weeks.  I had my first hormone therapy injection mid mid April 2018 and my  20 fractions of radiotherapy in August  and I have been on hormone therapy up to today. The point I would make is that I asked my oncologist about sport and everyone I spoke to stress the importance of keeping active and continuing your sport or activity  during PCa treatment.  I followed this advice and although the hormone therapy and radiotherapy has affected my fitness level and muscle tone I still manage an average of 90 to 100 miles a week albeit at a much reduced effort level as I tire very easily. But my point would be if you are a keen cyclist like me do not give up it has helped me immensely both getting over the treatment  and mentally 

Edited by member 25 Jun 2019 at 08:03  | Reason: Not specified

User
Posted 25 Jun 2019 at 09:48

hi Kevin

hopefully you or your brother don't join this 'club'

I was told about

https://www.icr.ac.uk/our-research/research-divisions/division-of-genetics-and-epidemiology/oncogenetics/research-projects/ukgpcs

when I was initially diagnosed  and brother, even though in Australia they contacted. 

I know some members on here have had DNA analysis, either free or £.

raises interesting issues obviously.   Incidentally I have 2 sons in their 30's.

My brother had a completely differing life style to me  and in a completely different geographical area from 1973.  yes we grew up in same town and family unit. same diet . exposures etc  until our teens.

all the best

Gordon 

incidentally my brother took 18mths from mpmri results before he had biopsy..  his PSA had been up to 18.    also during my biopsy I was told of calcium deposits by the guy operating gun.  first I had heard of this.  

seems previous prostatitis.. which I'm not sure I ever had can cause this.   Again you learnt so much and unless inclined to.ask. research  it's never mentioned.

 

 

User
Posted 25 Jun 2019 at 10:02

I was told I had calcium deposits when the urologist did a cystoscopy latter part of last year. I was told trauma could be the cause and I can only imagine it is from when they made my prostate bleed badly taking out a ureteric kidney stone in 2012. It was that bad they left me with a flushing catheter for 2 days. That said, perhaps the multiple cystoscopies I have had over the last few years have had an impact too.

User
Posted 25 Jun 2019 at 13:18

I do cycling, perhaps 50 miles/week on roads, but it's nearly all at my max output. I don't remember how long I stopped after the TRUS, but I do remember angling my seat downwards so there was no pressure on the perineum.

After the template biopsy, i was back on exercise bike after 4 days, and road bike after 8 days - could have been sooner but weather was bad.

I have not noticed a reduction in power due to HT, but I'm not racing so I would not notice small changes. (I must try a stint on the exercise bike, as that would show me.) I have bumped up my cycling to try and counteract a slight growth in body fat percentage.

User
Posted 25 Jun 2019 at 13:43

Can I ask what saddle you’re riding on?

I’m using Selle SMP Drakon saddles on my bikes at present 

User
Posted 25 Jun 2019 at 14:21

Originally Posted by: Online Community Member
Can I ask what saddle you’re riding on?

An obsolete Specialized one.
Looks a bit like a Specialized Avartar Comp Gel Saddle 2016., but top surface is smooth leather.

It doesn't work well tilted forward - I tend to slide down it. I need to look for something else.

User
Posted 25 Jun 2019 at 15:05
User
Posted 26 Jun 2019 at 10:42

As everyone assured me it would be, the scan was very straightforward 👍🏻(Radiologist confirmed that it was an mpMRI when I asked)

I did build up a bit of a rapport with the radiologist talking about my work as a police collision investigator prior to retirement and my ministry now as a Church of England vicar. Turned out his brother was a paramedic in Ireland and had seen and experienced some of the traumatic things I had too. Anyway, long story short... he put his arm on my shoulder and said ‘good luck with everything that’s ahead of you (me)’. Now I was thinking I might just have prostatitis but now I just want my results. I KNOW, I’m reading too much into a simple act of kindness and it seems to me that even I, who is normally calm and rational, have succumbed to irrationality of adding 1+1 together and thinking it could add up to 3. Hopefully have the results within 10 days.   

 

 

 

Edited by member 28 Jun 2019 at 18:01  | Reason: Not specified

User
Posted 15 Jul 2019 at 19:44

Having been told I can't cycle during RT, I just bought this noseless saddle for cycling during RT...

https://www.amazon.co.uk/gp/product/B07R61NZ4V

Just done a few miles, and it's OK. The lack of nose loses some lateral stability - I wouldn't want to use it for mountain biking, but it's OK on the road if you compensate with your arms and legs. I found I needed it tipped quite far forward to be comfortable.

I don't think you would get years of wear out of it, but it only has to last me 8-10 weeks, and that will be at reduced exercise levels compared with my normal.

I'll leave it a few days before trying it again in case there are any delayed action side effects.

User
Posted 16 Jul 2019 at 22:05

I am wondering why on earth you would be told you cannot cycle during your radiotherapy.

 At all stages on my journey I was encouraged to keep fit and not to stop cycling. The only time I was told not to cycle was after my transperineal template biopsy for obvious reasons. But two weeks after that procedure I was easing myself back into cycling without any problems. 

All the oncology staff I met told me that keeping fit during my radiotherapy and hormone therapy was key to getting the best outcome, physically and of course mentally. This is something I have found to be good advice. The main issues I have now are hot flushes and weight gain around the waist and breast but I am working on the latter hard

User
Posted 16 Jul 2019 at 22:33
Yes, John continued to cycle through RT as well - but there is perhaps a sound reason for the onco saying that in Andy's case it should be avoided 🤷‍♀️
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Jul 2019 at 08:47

Lynne

yes I suppose so. One reason I guess is if the Prostate is much larger than normal, cycling could inflame it making the daily RT session setup a problem

User
Posted 17 Jul 2019 at 10:17

The advice wasn't directed at me specifically - it's given for all prostate RT patients here. They said it's because the area will be inflamed, and cycling on it will make side effects worse.

Did a 10 mile leisurely ride yesterday shortly after RT on the new saddle, and it felt absolutely fine - no pressure on perineum whatsoever. I am noticeably lower energy levels - that's probably down to the RT which is known to have that effect.

User
Posted 17 Jul 2019 at 14:11

Isn’t it strange (or perhaps not!) that different NHS areas give different advice to patients receiving prostate radiotherapy, on how to care for yourself.

We as patients can only follow the advice we are given from our clinical professionals 

User
Posted 17 Jul 2019 at 15:08

Just chatted with a urological consultant radiologist at the Mount Vernon support group, and he is not hard against cycling during RT - just listen to your body and don't push it too far.

 
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