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experience with mpMRI fusion biopsy, neurosafe etc

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User

Posted 23 Dec 2020 at 23:39

Originally Posted by: Online Community Member

Its hard to see how any biopsy can find more than final pathology based on a removed prostate, but I could be wrong.

Simple sampling theory. Suppose you have a Gleason 3 + 4 = 7 tumour in your prostate. That's mostly type 3 cells with a smaller component of type 4. If the type 4 cells are all clustered in one place and the biopsy needle goes straight through it, you might end up with a misleading sample showing more 4 than 3.

Then your biopsy might diagnose Gleason 4 + 3, which erroneously puts you in a higher risk category.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User

Posted 24 Dec 2020 at 09:15

That makes sense, although surely its very important to know the most aggressive grade of cancer present. I don't see how a core biopsy could find a more aggressive grade than post RT pathology, but I can see how it could miss it.

Personally, I am just thankful that mine is miles away in a lab somewhere.

User

Posted 24 Dec 2020 at 09:32

Originally Posted by: Online Community Member

Agreed on the grades. I suppose there is the edge-case where different pathologists might differ in opinion?

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User

Posted 24 Dec 2020 at 12:23

Originally Posted by: Online Community Member

I am reliably informed that as of November 2020, 56% of areas across the UK do not provide multi parametric-MRI scans to diagnose PC, including all of Northern Ireland.

Its hard to see how any biopsy can find more than final pathology based on a removed prostate, but I could be wrong.

You will find this interactive map interesting - the vast majority of NHS Trusts offer mpMRI diagnostics to PROMIS standard but as you say, only one trust in Northern Ireland

https://prostatecanceruk.org/about-us/projects-and-policies/mpmri

I'm suspecting this concept may be going out of date.

A hospital near one of the support groups I run now preferentially does 3T MRI scans without contrast (bi-parameteric), and they're finding these at least as good as the 1.5T MRI scans with contrast. They now only do mpMRI scans when they can't get time on the 3T scanner. Another minor factor driving this is concern over a small number of gadolinium contrast reactions.

It would be good to see an update on this from PCUK.

User

Posted 24 Dec 2020 at 12:50

Yes but as far as I know there are still only 3 operational 3T scanners in England and one in Wales. Personally, I would like PCUK to campaign until every hospital trust in the country is working to PROMIS standard before they start campaigning for 3T - my worry is how trusts will find the money in the next few years to build large extensions to house the scanner in the way the Christie and Royal Marsden did.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 24 Dec 2020 at 13:47

Originally Posted by: Online Community Member

Yes but as far as I know there are still only 3 operational 3T scanners in England and one in Wales.

Really? The hospitals attached to two of the support groups I run have them (Reading, and Mount Vernon/Paul Strickland), and I assumed they were not particularly unique in that respect.

User

Posted 24 Dec 2020 at 15:12

Andy,

Reading has a fairly new Philips 3T MRI system. Super fast and good image quality as I travelled to access it. For my scans they still used contrast via IV (mpMRI). Image quality is good as I compared it to previous GEC 1.5T system data. Maybe more artefacts etc A common saying apparently is... ‘if you want 50 interpretations or an MRI ask 50 radiologists’.

UCLH also have 3T systems and one of the most respected radiologists in the UK as her skills are very well regarded. London Bridge also have a 3T system.

Simon

User

Posted 24 Dec 2020 at 15:32

This is a good read. I started in ISUP Grade group 1 after biopsy and got upgraded to ISUP Grade group 2 after post RARP histology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6798468/

User

Posted 24 Dec 2020 at 17:56

I started off T2a, but after the post-op biopsy I was ‘upgraded’ to T3aN1M0.

Anyway, so far so good!

Merry Christmas to you all.

Cheers, John.

User

Posted 24 Dec 2020 at 18:23

Cheers John! 🍻🥂🍾 Remember to share the wine with your loveliness 🤔👀👻

Merry Christmas one and all! 🍻🎅🏻

User

Posted 25 Dec 2020 at 00:27

The top focal urologist in the UK and highly regarded further afield says that the Prostate is the last remaining organ where it is removed in it's entirety as a matter of course. (There are of course cases where this is necessary). He contends that AS and if needed focal therapy as alternatives can help preserve function. It is known that many men who have radical treatment do not benefit from it and if not treated would have gone on to die of something else. This is called 'overtreatment'. About half of men over 50 years of age have (a) tumour(s) in their Prostate but it is only the significant ones that need to be treated. Therefore, each case should be considered and dealt with on individual assessment rather than rush into radical Prostatectomy.

I really recommend this video is viewed :- https://www.youtube.com/watch?v=2kRTwBJ8ehY

Edited by member 25 Dec 2020 at 00:28 | Reason: to highlight link

Barry

User

Posted 25 Dec 2020 at 11:26

I wouldn't disagree AS and if needed focal therapy are alternatives to RP.

I also wouldn't disagree they can help preserve function, that RP is not always successful or necessary.

I also would not disagree that most men over 50 years of age have tumour(s) in their Prostate but only the significant ones need to be treated.

I definitely agree each case should be considered and dealt with on individual assessment rather than rush into radical Prostatectomy.

HOWEVER, from personal experience I would say that RP can be the right choice (it was for me) and does not necessarily mean a poorer quality of life.

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