Comparing MRI Centers, MRI vs. PSMA/Pet for Lymph Nodes | Answering YouTube Comments #71 | PCRI
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- čas přidán 12. 01. 2022
- Alex asks Dr. Scholz questions from our CZcams comments on the topic of multiparametric MRI. Is there a significant difference between 1.5T and 3T? Should someone consider traveling from NC to NY to have their 3T mpMRI performed at a world class center? Are mpMRIs good at looking for prostate cancer in the pelvic lymph nodes? They address these questions and more.
0:09 What's the difference between a 1.5T and a 3T multiparametric MRI?
1:24 In people who have had hip replacements and are getting a 1.5T mpMRI, will they have to use an endorectal coil?
1:45 Regarding a 3T mpMRI, should someone in North Carolina consider traveling to world-class centers in places like New York City or would a high-performing center in North Carolina suffice?
3:58 What is the average cost of getting a second-opinion on an mpMRI?
4:09 Is a 3T mpMRI good at finding prostate cancer in pelvic lymph nodes, or should I just get the PSMA PET scan?
5:19 If an MRI or PSMA PET scan discovers lymph nodes that are suspected to have prostate cancer, do biopsies always need to be performed?
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At PSA 2.4 Twenty months Post RP and Nadir 0, PSMA Pet found 7mm iliac lymph nodes. I would not know to have pushed for this test without PCRI. When I asked my surgeon to order the test, his response was that "he heard something about UCLA doing that." When I need him to have a "peer-to-peer" conversation with insurance, I was told: "Dr. does not have peer-to-peer conversations with insurance companies." I ended up getting a Radiation Oncologist who would have the peer-to-peer. Start pelvic radiation on Monday. Thank you PCRI. I wish I had know of you two years ago. I truly think I would not be here now. It's the unknown that sucks life. Bright skies; PSMA-PET is our safety net to ensure we don't have anything going on unknown.
PCRI ....always superb advice....GO to a university medical center....they understand PCRI speak...they have the imaging modalities....thanks Dr Scholz & Alex et al....improving quality of life with a DX Pca. Not free of cancer until PET says you are.
I had a second opinion of an MRI scan & the expert identified the cancer. A subsequent PET scan showed that it had metatarsus to the lymph nodes. It was not covered by insurance but worth every penny (UK) of the £2500 that it cost. Thank you for the excellent information that you post.
I thought that the hot setup for prostate imaging was a Color Doppler Sonogram?
Is PSMA FDA approve now? I had it done back in 2019 at ucla, it wasn’t covered by insurance back then.
Yes, both the GA-68 PSMA PET scan and the DCFPyL PSMA PET scan are FDA approved.
So should it be practice to get a psma scan even if the mri shows the cancer is only in the prostate? Thanks
I do not want to speak for Dr. Scholz, but I believe it is a fair representation of his opinion that anyone with a Gleason 7 or higher should get a PSMA PET scan as part of the staging process, before treatment, to ensure that nothing has spread outside the prostate. PSMA PET scans are specific for prostate cancer and are significantly more sensitive compared to MRI, which is non-specific and can only detect large, bulky, metastases.
There are two types of PSMA PET scans, and so far, they have been demonstrated to have equal efficacy. The Ga-68, which is only available at some academic centers, and the DCFPyl (Pylarify), which is commercialized and more widely available. Pylarify is owned by Lantheus, and you can find centers on their website, www.pylarify.com/
Wow 🤩 what a jacket!
In this video, Dr. Scholz discussed getting an overread of an MRI . Would it be worthwhile to do this if the original reader determined that there is a high probability of cancer? The Pi-RADS in the MRI report indicated about 80% probability of cancer. But I don’t know if the reader might have made a mistake, because it was done at a local center that was not one of the “centers of excellence” mentioned by Dr. Scholz in the video. Also, the MRI might have been more difficult to read because it was done by a 2T MRI rather than a 3T, and because an endorectal coil was not used. So I’m wondering if it might be a “false positive” MRI, and whether I should send it to one of the centers of excellence for an overread. But I’m also wondering whether it would be worth it to do this when the local radiologist determined such a high probability of cancer, and also because my PSA level is pretty high, although I’ve read that PSA can also be high due to prostatitis, and I was diagnosed with prostatitis many years ago and I don’t know if it ever got cleared up. But I don’t know how high PSA levels can get with prostatitis. So another question I have is how high can the PSA level get when the PSA level is caused by prostatitis? I will appreciate your answer to these questions.
I would also be very interested in more discussion and response to these questions. I would also like to know more details about how to have a MR pelvis over-read at UCLA. Thank you.
I will add your question to our list for future videos. In the meantime, we have a helpline that may be able to provide you with some information. Our contact information is here: pcri.org/helpline
What do you think of PET axumin?
Watch Dr Kwon for 18F info.czcams.com/video/81iAzYV39Gw/video.html
I am glad I have my biopsy and PSMA done at ucla, but I had my HIFU done by Dr Robert Pugach at Pacific Coast Urology. ucla does not offer the ablation of the whole prostate at that time, maybe they do now, could anybody confirm this?
Hello,
Feel free to contact our free helpline. We have a patient advocate who will call you and may be able to provide you with some information: pcri.org/helpline
PSMA is not widely available. You should expect a biopsy of the prostate or a suspected metastatic lesion prior to being treated. Period.
I do not know if it is helpful, but here is a listing of locations with the most widely available form of PSMA PET, DCFPyL: www.pylarify.com/site-locator
I don't think he was advocating forgoing prostate biopsies (although, he has said before that he would like for the possibility to be investigated for elderly men in whom biopsies are much more dangerous) but just that in certain cases-for example, when the PSA and/or Gleason are so high that, historically, metastases would be assumed in the treatment plan anyway-that it may not be necessary to biopsy pelvic lymph nodes if the scan results are expected and unequivocal.
We have this video with Dr. Thomas Hope of UCSF, who led the team responsible for the approval of Ga-68 PSMA PET, in which he discusses the possibilities of false positives: czcams.com/video/8fajSFzRdlg/video.html