Understanding MRI Results

On the private front, I was also strongly advised by my GP to use the NHS for diagnosis. You get a Multi-Disciplinary Team (MDT) discussing your case each time a test result comes through - a team of up to 30 experts in all areas - surgery, radiotherapy, oncology, radiologist, etc. As a private patient, you usually have one consultant, and can easily be swayed to their own speciality. Even as an NHS patient, you can pay for extra diagnostic procedures (such as some types of scan the NHS doesn't do), and the MDT will use those results. When you get the MDT's treatment recommendation(s), you might then decide to have treatment privately, if you want to. Do make it clear when you talk with consultants that you are prepared to have private treatment - they are not allowed to raise it with you, but you can raise it with them, and ask if there's some extra procedure that might make a difference.

mpMRI - there are different ways of doing this. Contrast dye (gadolinium) is one way, but can't be used on patients with reduced kidney function (border line may vary, but I heard eGFI must be above 45). Newer MRI scanners have other ways to generate the 'multi-parametric' images. The heavy plate thing is called a coil. MRI scanners have lots of coils in them to relay the signals that come out of the body. Sometimes, they want to add more nearer the patient than are built in to the machine. It might be that this was used to generate additional images to form your multi-parametric scan, or it might just have been to produce a better quality image.

Ultrasound up your rear end isn't normally done inside an MRI scanner. (I can't imagine an ultrasound probe could work in an MRI magnetic field.)

The 1-6 are PIRADS scores. They indicate the probability of what the radiologist found as being cancerous, but note that an MRI scanner alone cannot diagnose prostate cancer - it can only hint where biopsy samples should be taken. It would also indicate where in the prostate the questionable area is, and what sort of biopsy would be required to sample it. TRUS (Transrectal ultrasound) is a common outpatient biopsy procedure, but can't reach the front of the prostate, and generally only takes 12 samples. A transperenial template biopsy is a theatre procedure under general anaesthetic (usually) and can take 30-60 samples much more accurately. If you haven't had a biopsy yet, I would ask for the transperenial template biopsy, and you might consider doing that privately. The TRUS is just starting to be phased out in some hospitals in favour of a new transperineal (non-template) biopsy, done as an outpatient procedure. TRUS has a higher infection risk (3%), whereas the transperineal biopsies are around 0.1% infection risk.

You can request a copy of your medical records, reports, and scan images. I did this after each significant new diagnostic procedure, and I keep a copy of all my records, test results, etc. Hospitals now have to provide them for free, within 30 days of request.

Edited by member 10 Jul 2019 at 10:32  | Reason: Not specified

francij1,

I don't think that mixture of NHS/Private would work as you describe. Private patients can't be discussed in the MDT, and NHS patients don't have a dedicated consultant. One of the consultants (usually urology, as urology run the MDT) will report back the MDT decisions/recommendations to you after the meeting, and discuss next steps. Having said that, I found it worked very well. I never felt rushed for time, and if I thought of something afterwards, I emailed the specialist nurse (Macmillan nurses where I am), and they went and got the answer for me. When I felt I needed more discussion with a consultant, I asked for that too, and the Macmillan nurses setup another consultant appointment within a few days (they set it after the next MDT, so I could be discussed again in the MDT beforehand).

The NHS is required to work with any appropriate private diagnosis and treatment a patient wants to have, and must share it's patient record to avoid tests having to be duplicated.

Clearly not all hospitals are the same. I have heard people on here being told they have cancer by a nurse rather than a consultant, but I'm pretty sure my hospital wouldn't do that (they have the nurse present who can take you aside after the appointment for a longer discussion).

So I think you will just have to await the outcome of the results of what I presume was a rectal TRUS biopsy. Two friends advised me against one of those as they both ended up having to have a transperineal biopsy subsequently as well. Buy one get one free!

If your number four figure is indeed Pirads 4, there is potential for concern, which the biopsy *should* resolve.

Best of luck.

Cheers, John.

Edited by member 10 Jul 2019 at 15:21  | Reason: Not specified

Well it worked for me,  I was diagnosed privately (MPMRI and biopsy), referred to "the best surgeon" within 100 miles. He saw me privately answered all my concerns and treated me on the NHS. 

I know it was the NHS because I was self funding and the major delay in my treatment was for the MDT review of the treatment recomendation and of course the waiting list.

After my 1 year follow up my local health board (Wales) refused to finance further hospital visits and wanted my GP to do follow ups, because I have a residual usPSA I was unhappy with this and just switched back to private so I could continue to see the same team. This included a Oncologist review and a second opinion on my final pathology.

So it can be done.