Wow there is a whole load of information for me there. I am from the UK and I think us prostate guys are less well informed than you guys in the States. Most of us also use the public health care scheme - the NHS. I think your posts reveal the gap between private and public funding.
I had my last biopsy 2 years ago, TRUS 12 core all clear. The MRI I had done before the biopsy showed some suspicious areas.(We don't have 3T MRI , just 1.5T in the NHS.) I think the score was 3. I didn't know you could have a MRI guided biopsy but won't be available on the NHS.
I don't know what my prostate volume is, nor %free PSA, density or volume. Rest assured I will be asking to see my MRI results and asking for this additional information. I will be having the MRI in 2 to 3 weeks time so will post again. I will be discussing many of the issues you raise with my consultant and may consider going private for the diagnostics. Thanks so much for all of your information and knowledge sharing and come on you Brits let's hear from you as well.
Unfortunately, according to my radiology friends (who may be a bit biased, as they participate in clinical trials for prostate cancer diagnosis using a 3T MRI machine), a 1.5T MRI just doesn't given enough resolution to be worthwhile in the diagnosis of prostate cancer.
I'm flattered, but truly the Urologist who posts here is far, far more knowledgeable than myself.
I have done my own research as BPH/PCa affects myself and first degree relatives.
It is important to stay informed.
E.g., my doc wanted to do a TURP. The procedure has helped many men and has had negative results on others. Surgical complications increase when prostate volume exceeds 80 cc. Many surgeons will go to other procedures for prostates over 100 cc. I am not a good surgical candidate for TURP. I'm glad I did the research instead of rushing into a procedure.
Michael
Just read this whilst i was researching the 1.5T versus 3T so maybe not as bad as it seems. I know I was in the MRI for at least half an hour to 40 minutes last time.
'You can still get beautiful images with a 1.5T system using multi-channel phased array coils, but scan times are longer than a 3T'
A 3 Tesla magnet produces much sharper image resolution than a 1.5 Tesla machine.
Diffusion weighted, multi-parametric 3T imaging is the present gold standard for non-invasive diagnostics.
TRUS biopsy is guided by ultrasound.
MRI fusion Bx overlays the MRI image and the Urologist uses that higher resolution image to guide the placement of the needles. It allows for targeting of areas of suspicion seen from the MRI.
A PIRADS score of 3 is considered indeterminate for the presence of clinically significant cancer. Basically, the imaging is unsure. PIRADS of 1 means almost certainly no cancer present whereas PIRADS of 5 means highly likely a significant cancer (Gleason score 6 or higher) exists.
The U.S. arguably has the best medical care in the world. Of course President Obama sought to derail that seven years ago via the Affordable Care Act. America does not need nor want socialized, government controlled medicine.
I hope you get your answers Andy.
God bless and keep you.
Michael
I would argue...France has an excellent health care...
Andy. Good luck to you but don't let them rush you into any surgery.I had a 13 core biopsy when I was 47. the doctor sent me to the urologist she told me I had cancer my PSA was 426. Get all the information you can Talk later my friend KEN
That may well be.
However, US hospitals and US medical schools dominate the world rankings and have for years.
People from the world over come to Johns Hopkins, Mayo Clinic, Cleveland Clinic, UCLA, UCSF, Univ of Michigan, Baylor Medical, Sloan Kettering, Mass General, MD Anderson, Northwestern Memorial, and many more for truly world-class, cutting edge healthcare. And the best students the world over come to US medical schools, of which essentially only Cambridge and Oxford compare.
But I have no reason to question France's health care.
Thanks,
Michael
If you have a 3T MRI and it is clear what is the point of a biopsy. If my doctor told me that I needed a biopsy after a clear MRI I would tell him or her to go pound sand. The 3T MRI should tell them if a biopsy is needed. If something suspicious shows up then a biopsy of that area is warranted, but to do a biopsy after a clear MRI just doesn't make sense to me. That is one reason why I didn't want a PSA test done, I figured I would embark on a journey of repeat testing for several years and biopsies are harmful to the body. Not something I take lightly. Lukily my PSA is .24, but that shows you how unacurate the PSA test can be, as I have an enlarged prostate, but low PSA. I was told that I have BPH. So, high or low it doesn't always mean you are clear or have cancer. I think the best possible test is the 3T MRI, I would trust it for myself. However, I am not a doctor and what I feel is right for me isn't going to be right for you, you have to decide what you would like to have done. Take care.