Can PIRADS Determine Treatment?, Detecting Pelvic Lymph Nodes
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- čas přidán 4. 04. 2022
- To find centers offering a PSMA PET scan, call: 1-800-964-0446. Visit www.pylarify.com/site-locator for more information. In this video PCRI's Alex and medical oncologist Mark Scholz, MD, discuss the roles and limitations of PIRADS (the system used to grade the level of suspicion that radiologists have when reading a mpMRI of the prostate) and PSMA PET scans.
0:09 Is the PIRADS score relevant for staging or is it just used to determine who needs a biopsy?
2:31 Are Gleason and PSA the main components of staging a newly diagnosed patient?
3:12 Link to staging quiz: pcri.org/staging-quiz
3:33 How useful is 3T MRI for finding cancer in pelvic lymph nodes?
5:42 What is the role of Axumin now that PSMA is approved and covered by my forms of insurance?
7:18 Are there tests available that will let a patient know whether or not their type of prostate cancer expresses PSMA and thus will show up on a PSMA PET scan?
8:22 How quickly will centers be providing PSMA PET scans? Find centers offering PSMA PET at www.pylarify.com/
Don’t know your stage? Take the quiz: Visit www.prostatecancerstaging.org
To learn more about prostate cancer visit www.pcri.org
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I have a suggestion for a discussion. When a tumor breaches the prostatic capsule but has not metastasized and perhaps low Gleason 7,8. Thanks
PSMA pets are available at Genesis on Colonial Blvd in Ft Myers Florida
With increasing obstructive symptoms and a PSA rising from 3.5 to 5 in almost 2 yrs., an MRI was done yielding PI-RADS 4 with 2 suspicious areas but no extraprostatic pathology evident. Multiple biopsies read as negative for CA at 2 major pathology labs. Active surveillance now.
As a matter of interest I had a Likert score 4/5 leading to biopsy which found only Grade 1, 1 core positive. A year later I had a PIRADS score of 2. So I'm pretty sceptical about this. I'm on active surveillance.
PI-RADS is used to report a radiologist's suspicion that a lesion detected on an MRI is cancerous. A PI-RADS 2 means that clinically significant cancer is unlikely to be present.
In March 2019 I had an Axumin scan followed 2 weeks later by a PSMA PET scan. My PSA was 4.0. The Axumin scan showed extensive lymph node involvement including inguinal nodes. The PSMA scan showed nothing in the lymph nodes - all clear. A year later, after 6 months on Lupron, a CT was performed and compared to the CT done in 2019. It showed no change in morphology in any lymph node. This seems to indicate that the Axumin results may have been false positive. In 2020 I had radiation to prostate and pelvic lymph nodes. I think the inguinal nodes were outside the radiation field. Two years post radiation my PSA is 0.04. My sense is that had there been cancer in the inguinals the PSA would be higher today. However I am still left with lingering doubts.
Why not just biopsy one of the nodes?
Thank you for the video. I was wondering about the intake of calcium supplements when someone has prostate cancer with multiple bone mets. Some people say calcium intake will cause bone mets to spread more and PSA to increase due to the cancerous bone growth due to the calcium rebuilding it. Then others say the calcium is needed to repair the bone damage from the cancer and prevent breaks. Which one is correct? Same question for iron.
Hello, I will add this to our list of questions for a future video. In the meantime, you are welcome to contact our free helpline. We have a patient advocate who may be able to help with your question. You can find our contact info at pcri.org/helpline.
Doesn’t MPRI help decide where to do a targeted biopsy if needed, rather than just randomly pull samples? There are studies that indicate a MPRI combined with a PSMA PET scan have a greater degree of accuracy than a grid biopsy. The accuracy numbers I see reported for grid biopsies is not nearly as high as the PET and MRI combined. I had a nodule, knowing now that it has not spread and no structures around the prostate are affected gives me huge peace of mind that a grid biopsy would not. Plus I avoided any of the risk factors and recovery from a biopsy. I may end up getting a biopsy, due to insurance, but I probably will end up getting a PET anyway. Why not use the best imaging techniques that are available before you poke the bear, rather than after?
I am a bit confused as another video you made seems to highly recommend both the MRI and PET. Biopsies have an unacceptable error rate. I see error rates of 30-40% mentioned.
Isn't 39 percent 4 PIRADs come back negative. Or show up inflammation a year later?
Thanks a lot for the informative videos. When chemo should be started? Is it should be after medical castration that is 2 or three months after ADT + AA or straightaway after diagnosis ?
I am not sure of the exact sequencing that situation, but our helpline would probably be able to help you with that. You can find our contact information at pcri.org/helpline.
I had pirads 5. Initially Elected to only biopsy 3 cores from the tumor. But I was so comfortable with Valium, I told the doc to also do the random 14 cores. Results: all 3 cores from MRI pirads 5 Gleason score 7. Four random cores Gleason 7. No side effects, minor bleeding.
Would you recommend taking turkey tail mushroom , have been told that taking this mushroom can and does eradicate cancers