All posts by Darren K

Clinical Trials with Advanced 3T Prostate MRI

The prostate MRI like the one I had is not unique.  I mentioned in an earlier blog that a urologist in Florida does 3T MRI screenings for a fee, some of which is paid by insurance.  This is also an area with clinical research, such as the study I entered at the NIH.  I was told that I was somewhere around the 75th patient in this particular trial.  I believe this is the link for the trial I entered, but it may be a related trial and not the exact one where I participated:

http://www.clinicaltrials.gov/ct2/show/NCT00182624

Other major centers are doing similar research, notably, the MD Anderson Cancer Center in Houston, Beth Israel Deaconess Medical Center at Harvard and Memorial Sloan Kettering Cancer Center in New York.  These are all among the top research institutions for prostate cancer.  You can search for such trials at www.clinicaltrials.gov.  Here’s a few I found that might be similar:

http://www.clinicaltrials.gov/ct2/show/NCT00588679

http://www.clinicaltrials.gov/ct2/show/NCT00429338

http://www.clinicaltrials.gov/ct2/show/NCT00831142

These are just a few active studies I found that appear to be recruiting participants.  These may vary from the study I entered in important ways, so you would need to read about the details and contact the researchers to make sure the study applies to you.  For example, some may have age limits or require that patients have a positive biopsy result for prostate cancer.  There may also be other studies I didn’t find in a quick search, or those that are still open but not actively recruiting.  It doesn’t hurt to email a researcher if you find one like this.  Clinical trials aren’t for everyone.  They may or may not help in a diagnosis or treatment.  You have to do a lot of your own research to determine if one is right for you.  Remember that not only might a clinical trial help you in the short term, but they will help others in the long term by advancing the technology for detection and treatment of prostate cancer.

Heading Home

My TRUS/MRI fusion biopsy is now over and the joy of waiting 2-3 weeks for the pathology results begins.  The good news is that Dr. Pinto thought it was very unlikely there would be any findings, given all my results so far.  In addition, he said they were unable to reproduce the dark (hypoechoic) region that was a concern to Dr. Bard on his ultrasound.  He said that one very low risk area they did target may have been in the same general area, but I inferred that there just wasn’t enough information to correlate them from the limited 2D ultrasound images I received from Dr. Bard in New York.  From what I’ve gathered, ultrasounds of all types are not always consistent and can even be manipulated to some degree, thus one of the reasons they aren’t widely accepted for prostate cancer detection.

I also got the results of my PSA blood test measured at the NIH.  It was 2.7, the same result I had at my urologist in late 2008 and essentially the same result as the first reading of 2.5 I had almost one and a half years ago.  This is also a bit of good news, as a rapidly rising PSA level can also be an indicator of prostate cancer. One study of PSA velocity indicated that a change of 0.75 in one year is a concern, while a change of 2.0 in one year suggests a higher risk of aggressive prostate cancer.   My level is essentially unchanged or a very slight change, as I understand that day-to-day variations can easily account for a few tenths of a point.  So, if my level was to go up to 3.5 or so a year from now, that would probably be a concern, while a smaller increase may be more indicative of prostatitis or BPH. 

Anyway, I was discharged from the NIH this morning and am waiting at Reagan National Airport for my flight home.  I haven’t had a fever since yesterday morning.  I do need to continue my course of prophylactic antibiotics (Cipro) for 2 more days.  Otherwise, I’m feeling pretty good.  No issues with blood in urine since the first few hours after the procedure.  I do have a slight bloody nose this morning, though.  I gather it was probably pretty dry in the hospital, especially considering the cold wave that hit while I was there.  It was about 15 degrees outside.

My room mate was in fair condition.  Recovery from a radical robotic prostatectomy isn’t easy and I’d guess his was pretty typical for the first day.  Fortunately, it didn’t sound as if there were any serious complications and I wished him a speedy recovery.

My Dreaded Prostate Biopsy

From the beginning, the pretense of my blog has been that many biopsies are probably unnecessary, given the sheer number that are done (about a million a year) and the large percentage that turn up negative.  I didn’t have any “smoking gun” that indicated I was at risk, other than a PSA level that was somewhat high for my age.  In fact, my DRE and PCA3 tests did not indicate suspicion of cancer and my ultrasound and MRI results only had minor areas of suspicion.  Had they been completely normal, I probably would have opted not to have a biopsy at this time.  In that the MRI identified at least one suspicious area deemed very low risk, the biopsy seemed necessary. 

(There’s a little TMI in this long blog entry, so don’t read on if that kind of detail makes you queasy or whatever)

I was nervous about it, having postponed mine for two months now.  Reading all the internet horror stories didn’t help, either.  It didn’t help much knowing that the odds of being one of those horror stories are very long.  After all, my experience with urologists includes a failed vasectomy.

Continue reading My Dreaded Prostate Biopsy

3T MRI Diffusion/Spectroscopy Results

I have a summary of results from my 3 Tesla high resolution MRI, given to me by one of Dr. Pinto’s associates.  I am told this included a T2-weighted (T2W) 3T MRI scan.  If I understood correctly, they also took scans with spectroscopy (MRIS) and then with diffusion weighting (DWI) as well and finished with contrast enhanced (CE) images that I assume related to the injection I was given.  I was told the report indicated that there were no suspicious lesions whatsoever(!).   The only finding was a pattern consistent with prostatitis (non-malignant infection or inflammation of the prostate).  Very good news, but again it’s an experimental trial so it can’t rule out prostate cancer.  I was also told that the radiologist, Dr. Choyke ,consulted with the urologist I saw yesterday, Dr. Pinto.  Having been advised of the ultrasound findings I gave them, I have the impression that the radiologists took a second look at the area in question.  They apparently decided that there may be one area of interest, but deemed it very low risk.  So, I will proceed with biopsy tomorrow, including a “fusion” biopsy targeting the one suspicious area.

I am hopeful the biopsy will be negative and that all I have is indeed prostatitis.  Of course, even a negative biopsy report is not enough to rule out cancer and this has been the basis of my blog.  On the other hand, I’m at the point where the only other alternative available to me is “watchful waiting”.  So, I decided to have the biopsy and pray it will help to put my mind at ease.   After all, I’m already admitted to the NIH, it will be done in an OR and under mild sedation.  Plus, it’s free.   Combined with the targeted fusion system, it’s a more comprehensive alternative compared to a typical outpatient prostate biopsy procedure.  Assuming the biopsy is negative, I would then still continue with routine PSA/DRE at my checkups to make sure nothing changes, but I will do so knowing that no available test could confirm the presence of cancer.

First Day at the NIH

Despite nearly being stuck at O’Hare airport in Chicago due to thunderstorms, my flight managed to depart for Reagan Washington National.  For anyone looking for a hotel near the NIH, I’m staying at the Hyatt Regency Bethesda until I’m admitted on Sunday.  The Hyatt is very conveniently located right atop a metro station.  One transfer between the airport and hotel, very handy.

My next day started at 8AM.  The NIH was one stop away on the metro.  After checking in through security, I walked to the main building, #10.  Registration was relatively quick, with fewer forms than a typical office visit.  The nurse who had been corresponding with me via email (Celene) then met me to show me where I’d be going throughout the day.  My next stop was at the lab for blood and urine samples.  Then to radiology for a chest X-ray.  Then to have an EKG.  Everything was very efficient, so much so that I finished over an hour earlier than scheduled and had time to take in a light breakfast.  The staff has also been very professional all around.

My 3T MRI with spectroscopy was delayed a little, but went without a hitch.  It was quite an extensive scan, taking about 1 hour and 10 minutes in the tube.  Even with earplugs and headphones, it was fairly noisy.  I also had the displeasure to experience the “Endorectal Coil” used to enhance the images.  Getting it into place wasn’t very pleasant, but it was tolerable for the rest of the exam.  Another set of enhancement coils was set on top of me.  Near the end of the scan, they injected me with gadolinium to enhance the last set of images.  They also took additional images at without the coils before I was finished. Continue reading First Day at the NIH

Making A Difference

I don’t plan to be racing anytime soon in order to raise funds for worthy charities related to supporting prostate cancer research.  Instead, I’d like to give credit to another Darren who is my age and is now racing for a cure:

http://darrenritch.blogspot.com/2009/02/help-me-make-difference.html

If you are considering a charitible contribution for medical research, please take a look.  Prostate Cancer is among the most common and most deadly of all cancers.  Also, if you have the time, take a look at Darren’s blog.  It’s a compelling journal of his experiences.

I’m off for my trip to the National Institutes of Health this week for my 3T MRI, possibly followed by a biopsy.  I’ll have more to write this weekend and next week.

Ultrasound Images At Last

prostatedoppler$950 later, I finally got a whopping five ultrasound images.  This was from my prostate ultrasound test in New York City last month by Dr. Robert Bard.  The lure of the “3-D/4-D” power doppler sonogram was the promise of hundreds or thousands of color enhanced images that could be turned into a three dimensional view that would also show motion in real time.  What I actually received after my appointment was a single, 1990s fetal-ultrasound-quality, black and white polaroid-sized image.

Prior to the appointment, I specifically asked if the images would be available to me in some format for a second opinion, if necessary.  In reviewing the cryptic response from the Dr. Bard, it seems it might have even been intentionally vague or even dodged the question altogether.  I guess that should have been a red flag.  Nonetheless, after the ultrasound, he said a partial set of images would be available and referred me to his staff.  I was sent a single black and white digital image, though it was at least more detailed than the polaroid.  I repeated my request and got no reply.  After a couple weeks, with my next consultation looming for the MRI, I sent another request.  A few more exchanges resulted in five images being sent to me, as the previous email with the first image must have been corrupted.  Apparently, five images were all they kept!  For all the promise of this technology, they claim to have kept only five 2-dimensional images out of thousands, with zero benefit of 3D or 4D available to me for future reference or a second opinion! Continue reading Ultrasound Images At Last

Get Checked.

It’s OK to be fearful of an invasive procedure.  A little fear can lead to a second opinion, maybe a better one.  On the other hand, a little fear shouldn’t keep you from getting checked at all.  Since I have no medical training, I can’t give specific advice on what someone else should do, once they find out there is a medical concern.  I can give advice on what you should do if you don’t think you have a problem, though.

If you’re 40 or older, have your physician add PSA level to your blood test at your routine checkup.  Have him do a DRE.  These simple things could catch a disease before it becomes life threatening.

If you’re in a high risk group, have this done before you’re 40.  If you haven’t had a routine physical in a while, schedule one today!

Prostate Cancer isn’t some rare disease that happens to that other guy.  It’s the second most common cancer in men and also the second leading cause of  cancer death for men.  In fact, one man in six will be diagnosed with prostate cancer in their lifetime.  I had no idea I had an enlarged prostate or high PSA level.  I still have no physical symptoms whatsoever.  Prostate cancer may not cause any symptoms, until it’s too late.  Don’t leave it to chance.

That’s pretty much all I have for now.  I’ve caught up on most everything I’ve learned in the last few months.  I won’t know much more about my situation until early March.  I will blog here and there as I find interesting websites or research, but probably not on a daily basis.  For now, I have not been diagnosed with cancer and I hope I can report the same in future blogs.  Thank you for reading and for your support!

Darren

Getting a Baseline: A Hassle But Not a Waste of Time

The time and expense involved in having all these tests may seem like a lot of effort in order to avoid a biopsy.  Based on what I’ve learned so far, an invasive “random” biopsy (with its associated risks) still doesn’t seem like the best course of action for me, given my results so far.  Alone, PSA levels, DRE, a PCA3 test, a power doppler ultrasound or a 3T MRI scan may not be any better than a biopsy as a method to rule out cancer.  Combined, I suspect they could indeed be enough to detect cancer with a reasonable degree of sensitivity.  Plus, in the case of the ultrasound and MRI, they may also even be able to help guide a biopsy to a suspicious location.

There’s another reason all these tests may come in handy.  Even if I don’t have cancer, I know something is up with my prostate.  It might be prostatitis, it might be BPH, it might just be the way I was born.  Years from now, I may start to have another prostate issue.  In fact, a large number of men do get prostate cancer at some point in their lifetime.  What I will have now is a baseline for PSA, PCA3 and MRI results to compare to any lab results in the future.  I had hoped to have the same for ultrasound results, but that has been a disappointment so far, but I’m not sure if that is related to the physician, the ultrasound technology itself or both.  Anyway, these results can also help detect changes that might be important and rule out anything that may not be of concern because it hasn’t changed much over time.

At the very least, I’ll probably have my PSA level checked every 6 months to a year.  If PCA3 testing becomes more widely accepted, perhaps I will do that annually, also.  If one or both of them go up significantly, then it might be time for some other action.  Of course, this all depends on the results of my MRI/biopsy next month.

Another Bit of Good Fortune: The Frugal MRI

I was a bit discouraged about the cost of having a new, high resolution prostate MRI.  $5000 is a lot of money, especially in the current economy where it could pay bills for a couple months, as layoffs are looming everywhere.  There had to be something similar and less expensive in the Chicago area.  With major universities like the University of Chicago, Northwestern, Loyola and the University of Illinois at Chicago, someone had to be doing it.  That’s not even including the dozens of private hospitals and clinics in the area and other nearby universities like Iowa, Purdue, Wisconsin and Illinois.  Still, I could find nothing on almost every kind of search I tried.

What I did find was research.  Names and email addresses of urologists, radiologists and others who were doing work in prostate imaging.  One of them might know someone else doing this kind of diagnostic for patients, maybe even in the Chicago area.  I also contacted some local people who came up on a search of seminars in the local area, some through a great organization called UsToo.  Still, nothing I could find anywhere in the midwest.  The major institutions doing this type of research seem to be in Boston, New York City, San Fransisco, Houston and Maryland. Continue reading Another Bit of Good Fortune: The Frugal MRI