← 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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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.

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Replies to "I do think you are doing all the right things from sound of it. The thing..."

Thanks for the MRI information.

From my research, the BRCA1 gene (and others) are evaluated via “germline genetic testing” from a person’s DNA profile obtained from blood or saliva samples. It is looking for inherited genetic mutations.

“Genomic testing” is done on cancerous tissue taken from the prostate (either biopsy or after RP) in order to provide information about how one’s prostate cancer might behave in the future.

Decipher, Prolaris and Oncotype DX are genomic tests, all of which vary in purpose but are used to evaluate aspects of the genetic makeup of the cancer cells themselves.

For those in my situation (initial diagnosed with low or intermediate risk PCa) it seems genomic testing would be the only one of interest.

For advanced PCa, where the efficacy of various ADT therapies are in question, genetic germline testing may be useful to determine the “best” chemical treatment.

Of course, family members who are curious as to whether they have inherited a genetic propensity toward PCa, because it runs in the family, may also take this particular germline genetic test…but I’m not sure what they would do about a “positive risk” result.

IMHO there are some questions that are best left unanswered. It may be easier to live with this kind of a question, than an undesirable answer….but others may think differently….