← Return to Multiparametric MRI (mpMRI) over diagnosis?


Multiparametric MRI (mpMRI) over diagnosis?

Prostate Cancer | Last Active: Dec 14, 2023 | Replies (32)

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@ bjroc:
I’ve read and heard mpMRI’s are known for their lack of consistency among interpretations by radiologists and that one is not “fully trained” until having seen nearly a 1000 or so scans. Don’t know about “contrast dye” vs “diffusion weighted” interpretations, but I appreciate your experience.

Regarding genomic testing, I spoke to someone from Myriad Genetics about the Polaris test, but my doc recommended Decipher when I asked that genomic testing of my biopsy cores be performed.

My reasoning is that genomic test is another independent, risk assessment tool. Apparently the Decipher test is the only gene expression test with Level 1 evidence for validation, as it compares the genetic fingerprint of one’s PCa to that in their database of >110K men, regarding the propensity of ones cancer to metastasize.

Since my diagnosis, at this point, is technically “Intermediate Risk - Favorable”; if my Decipher score is under 0.50 it will mean my PCa’s “genetic fingerprint” indicates it is no more likely to metastasize as a man with a “very low risk” or “low risk” diagnosis. This will boost my confidence regarding my AS decision. Of course, if higher than 0.5 the reverse will be true. Genetic info is a double edged sword….

At this point, I’m comfortable with the reasonable risk approach of AS. Especially when juxtaposed alongside the high risk of short term side effects and significant risk of longer term side effects of ALL treatments options for which I’m currently aware.

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Replies to "@ bjroc: I’ve read and heard mpMRI’s are known for their lack of consistency among interpretations..."

I do think you are doing all the right things from sound of it.

The thing is diffusion weighted MRI is the way all MRI of other places in body work to pick up tumors. Have an MRI of the brain looking for tumors, well they are going to look at diffusion weighted images. So it is a inherent part of MRI itself, unlike contrast agents which are external and injected. All my MRI of prostate went through Mayo, even several radiologists. None used the diffusion weighting so contrast has too much say in the prostate field - at least it says that to me.

With genetics there can be 50 differing polymorphisms (SNPs) that pooled together give a kind of risk probability. One company may use 12 of the SNP's, another company overlaps and does a few more. Probably none uses all the polymorphisms known as relating to PCa. But some tests are slightly better - but it is still a bit Las Vegas right now. One still does it to confirm AS, but some places just look at BRCA1 gene or something I understand. For whatever reasons they say it is just as good as an indicator, but I can't say why. Hopefully the insurance covers it too as it can get tricky on those tests.