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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2008Imaging
I'm wanting some imaging before choosing an oncologist. My urologist says I need to chose an oncologist before I can get imaging. That makes no sense whatsoever. Do some oncologist only rely on certain types of imaging? If I get MRI and/or MRIS, and Carroll/Shinohara use color doppler, will they not use the MRI? On March 22, Dwight wrote: > I'm wanting some imaging before choosing an oncologist. My urologist > says I need to chose an oncologist before I can get imaging. > > That makes no sense whatsoever. Seems to me that the oncologist will know best what imagery would be most helpful. > Do some oncologist only rely on certain types of imaging? > > If I get MRI and/or MRIS, and Carroll/Shinohara use color doppler, will > they not use the MRI? I suggest asking them. Regards, Steve J Twix and twain? I have decided to go out my HMO plan and consult an oncologist. We had our initial meeting Friday and after taking my history he scheduled me for a bone scan and a pelvic Cat Scan (hope I have that right). After I get those scans he will send me to the Radiological team to determine if radiation therapy is appropriate. When it was first determined that my PSA was rising the urologist wanted to start me on Hormone Suppressant Therapy. Reading the side effects I decided to get the second opinion. The urologist may well be correct and HST may be the appropriate treatment. But I do believe I moved too fast in 1996 and went for the Radical without a second opinion. These are life altering treatments. I want all the information I can understand. I did buy two books recommended on this list-Strums Prostate book and Dr. Scardino's. I am a truck driver, it is hard reading for me. But at least I get some questions to ask. We don't have to rely on one Doctors opinion. > On March 22, Dwight wrote: > [quoted text clipped - 16 lines] > > Steve J > On March 22, Goofy wrote: > [quoted text clipped - 16 lines] > > Steve J Sunnybrook's Dr. Loblaw does not generally expect his patients to bring their own imagery. I can understand that Goofy no longer trusts his urologist, but on this one he appears to be right. Wonder whether Goofy's glucose deprivation therapy will work. > Sunnybrook's Dr. Loblaw does not generally expect his patients to bring > their own imagery. I can understand that Goofy no longer trusts his > urologist, but on this one he appears to be right. Wonder whether > Goofy's glucose deprivation therapy will work. Don't call me Goofy. My name is Doofy. ;-) >> Sunnybrook's Dr. Loblaw does not generally expect his patients to >> bring their own imagery. I can understand that Goofy no longer trusts >> his urologist, but on this one he appears to be right. Wonder whether >> Goofy's glucose deprivation therapy will work. > > Don't call me Goofy. My name is Doofy. ;-) ROFL!! If anyone should be called "Goofy", it would be a$$fire...... Dr. Loblaw of Sunnybrook Hospital is my husband's doctor and is in Toronto, Ontario, Canada!! Obviously his knowledge of geography is sadly lacking. Along with other things. And au contraire (if a$$fire understands French)....we did take one xray down to him on Day One.....thereafter he was in charge of all of the rest of the scans, etc. But hey, Duh-white.....if you want to change and come up here for treatment, by all means, come on up. (G) Happy Easter All.....Heather. > But hey, Duh-white.....if you want to change and come up here for > treatment, by all means, come on up. (G) I can't give an honest response on the newsgroup. ;-) >> But hey, Duh-white.....if you want to change and come up here for >> treatment, by all means, come on up. (G) > > I can't give an honest response on the newsgroup. ;-) Oh, you COULD ... several of us have... but it does no good. ;-) I.P. >> Sunnybrook's Dr. Loblaw does not generally expect his patients to >> bring their own imagery. I can understand that Goofy no longer trusts >> his urologist, but on this one he appears to be right. Wonder whether >> Goofy's glucose deprivation therapy will work. > > Don't call me Goofy. My name is Doofy. ;-) Oh, I am sorry Goofy, I thought it was Dwight. Anyway, if you need an introduction to Loblaw, I'll be glad to give you one. We live in Forest Hills, quite near the Hospital. >>> Sunnybrook's Dr. Loblaw does not generally expect his patients to >>> bring their own imagery. I can understand that Goofy no longer [quoted text clipped - 6 lines] > introduction to Loblaw, I'll be glad to give you one. We live in > Forest Hills, quite near the Hospital. LOL!! WRONG!! You slipped up again, dolt......and trust me, I will catch your errors every time. It is SO obvious that you are NOT Canadian, and you would have to live here to know how you erred. Luser!! > I'm wanting some imaging before choosing an oncologist. My urologist > says I need to chose an oncologist before I can get imaging. [quoted text clipped - 5 lines] > If I get MRI and/or MRIS, and Carroll/Shinohara use color doppler, will > they not use the MRI? There is a distinction between a radiation oncologist who specializes in treating prostate cancer with radiation and a medical oncologist who specializes in treating prostate cancer by drugs, either HT or perhaps chemotherapy. Unless I' missing something, it wouldn't make much sense, given your age and biopsy findings, to refer you to a medical oncologist at this point. A radiation oncologist, on the other hand, might be more knowledgeable than a general urologist about the use of imaging techniques and their interpretation. He/she may even supervise the imaging which most likely will be done by a technician. >> I'm wanting some imaging before choosing an oncologist. My urologist >> says I need to chose an oncologist before I can get imaging. [quoted text clipped - 15 lines] > imaging techniques and their interpretation. He/she may even supervise > the imaging which most likely will be done by a technician. Maybe instead of oncologist, I should have said doctor. Given the choice of radiation vs surgery, seems I still need to get some imaging to know which way to go. >>> I'm wanting some imaging before choosing an oncologist. My urologist >>> says I need to chose an oncologist before I can get imaging. [quoted text clipped - 20 lines] > choice of radiation vs surgery, seems I still need to get some imaging > to know which way to go. Things may have changed, but it used to be the case that imaging techniques were used to see if there was any evidence of spread of the disease. For early prostate cancers with moderate Gleasons, many urologists didn't bother with such imaging because the likelihood of finding anything was very small. Perhaps things are different now, but when I was treated in 2000, imaging studies wouldn't have been of much help indeciding between radiation and surgery. >I'm wanting some imaging before choosing an oncologist. My urologist >says I need to chose an oncologist before I can get imaging. > >That makes no sense whatsoever. > >Do some oncologist only rely on certain types of imaging? <snip> My progression on imaging post PSA was: External Ultrasound req by GP 10 core Biopsy req by Urologist #1 post DRE. A whole raft of X-rays, CT Scan, Full Body Bone Scan req by Rad Oncologist prior to ADT, XRT & HDRB. Flexi-Cystoscopy req by Urologist #2 prior to HDRB. After that, I've lost count :) -Please reply to group as my email addr is fake! -Regards CC > <snip> > My progression on imaging post PSA was: [quoted text clipped - 5 lines] > > After that, I've lost count :) Doofy, I think Clarence is pointing out here that you really don't know what imaging to get. Would you like transrectal ultrasound, color doppler ultrasound, MRI, endo-rectal MRI, CAT scan, bone scan, PET scan, Prostascint scan, cystoscopy, proctoscopy, or ordinary x-ray? Every single one of those has been used in prostate cases. Would you like it from the top, the left side, the right side, the bottom, or from some angle? What exact region would you like to be imaged, at what magnification and with what imaging strength? And after you get the results, what are you going to do with them? Will you be able to tell what's a tumor and what's not on an endo-rectal MRI? Will you be able to tell where the seminal vesicles are, where the lymph nodes are, or for that matter, what part of the image shows the prostate? What exactly will you be looking for to help you determine what kind of treatment to get? Bear in mind too that imaging isn't always non-invasive. CAT scans, for example give a pretty good dose of x-rays to the body. Bone scans involve injection of radioactive isotopes. The effects of these are cumulative over the course of your life. You don't want unnecessary imaging. Also bear in mind that imaging can be VERY expensive. You may not care if your insurance pays 100%, but the insurance company sure won't pay for imaging not ordered by a doctor. I'm guessing that you won't be able to select what kind of imaging is appropriate, what it means, or how it might impact the choice of physician or treatment. My advice is, consult a surgeon - the best one you can find based on people's recommendations. Also consult a radiation oncologist, again the best one you can find based on people's recommendations. Prepare lots and lots of questions before you go in. Ask questions about all of the things you were hoping to find out from imaging. Then pick a treatment based on your reading, your feelings about the surgeon and the rad onc, and your priorities with regard to side effects. Whoever you pick will prescribe the kind of imaging he needs to do his job. Best of luck. Alan > And after you get the results, what are you going to do with > them? Will you be able to tell what's a tumor and what's not on > an endo-rectal MRI? Will you be able to tell where the seminal > vesicles are, where the lymph nodes are, or for that matter, what > part of the image shows the prostate? I get your drift. I didn't intend to try to be my own doctor, but was hoping there's some gold standard of imaging that someone like a urologist could have done, and then go from there. I'm gradually seeing that there is not. > What exactly will you be looking for to help you determine what > kind of treatment to get? [quoted text clipped - 4 lines] > effects of these are cumulative over the course of your life. > You don't want unnecessary imaging. Yes, I know. MRI seemed less detrimental. Don't even know what color doppler uses. > My advice is, consult a surgeon - the best one you can find based > on people's recommendations. Also consult a radiation [quoted text clipped - 4 lines] > reading, your feelings about the surgeon and the rad onc, and > your priorities with regard to side effects. Yes, so far it's just getting through the bureaucracy to get to the surgeon I'm getting the most recommendations on. Recommendations from my GP and from someone I know who's been through this, and did a lot of research. I don't want to have to wait months just to see what's going on insude me. > > And after you get the results, what are you going to do with > > them? Will you be able to tell what's a tumor and what's not on [quoted text clipped - 34 lines] > > I don't want to have to wait months just to see what's going on insude me. Doofy As I have been having almost every conceivable scan for the last 9 years, I'll give a quick summary. There is no scan that can find cancer cells at a cellular level, the earliest detection is probably PSA as it will generally indicate a rise in PSA for a tumour of 1 mm (research at McGill university). If you are looking for precision, there is non such scan - they have their strengths and weaknesses. On diagnosis when the PSA is less than 20, CT scan or regular MRI are not helpful. Generally at diagnosis, the interest is extent of cancer and whether it has spread. Color doppler ultrasound may help ensure that the major nodes of cancer are found and then biopsied. (no personal experience here) MRI with spectroscopy as practiced at USCF may help further outline the extent of the cancer as long as no medications ahve been used that shrink the prostate. (this was done after I was on hormonal therapy for 10 months - it was useless as the gland was denser due to ADT and could not detect the cancer) Prostascint fused with CT scan (as practiced by the late Dr Sodee) is good for detecting node metastisis, I don't know who has the equivalent expertise now. (I had 4 PS scans - 2 by Sodee which were very helpful and 2 others before without CT fusion which were totally useless) The invasive way to test for node metastisis is by surgical sampling which is limited to the pelvic area, none remote and may not get all of them. It is possible to have conflicting results and how to decide which is correct. If you have a technical background Doofy - you will be frustrated by the lack of precision in medicine. When I asked the head of pathology at a teaching hospital about this lack of science, he replied that is why it is called "the practice of medicine". In the end, you do have to choose the best practitioner. When there are no definitive cures, then it helps to consult many practitioners and learn enough to make a decision that you can live for the rest of your life since they all leave you with adverse effects. Good luck Lud > On diagnosis when the PSA is less than 20, CT scan or regular MRI are > not helpful. Generally at diagnosis, the interest is extent of cancer > and whether it has spread. My PSA is .8 or was a few weeks ago. > Color doppler ultrasound may help ensure that the major nodes of > cancer are found and then biopsied. (no personal experience here) I'll be having that in May. > MRI with spectroscopy as practiced at USCF may help further outline > the extent of the cancer as long as no medications ahve been used that > shrink the prostate. (this was done after I was on hormonal therapy > for 10 months - it was useless as the gland was denser due to ADT and > could not detect the cancer) My prostate is small, but not due to medication. > > On diagnosis when the PSA is less than 20, CT scan or regular MRI are > > not helpful. Generally at diagnosis, the interest is extent of cancer [quoted text clipped - 14 lines] > > My prostate is small, but not due to medication. Having cancer is a bummer - you are very lucky for the early diagnosis and you will be fine - you have some great artists in your area. Lud Leonard Evens wrote: > Things may have changed, but it used to be the case that > imaging techniques were used to see if there was any evidence > of spread of the disease. For early prostate cancers I was diagnosed in May 2001 and the urologist sent me for a scan in late summer/early fall (can't remember the month). After I changed urologist (for a 2nd opinion) and agreed to submit to radiation, I was sent for another scan in November 2002. In both cases, the radiologists/doctors were unable to "read" the scan or make a determination because of the damage caused by a minimum of 25 years of ankylosing spondylitis. ___ Blue Wave/QWK v2.12 Doofy, Read the following, which I just posted this on my blog. I would ask my doctor for an eMRI. And if he doesn't have the equipment go elsewhere. And welcome to the club. Contrary to what people think, membership does have its privileges. Now playing in L.A. (where else?) is a play called: "Testosterone: How Prostate Cancer Made A Man of Me". If you're a cancer survivor, you get $5 off the price of a ticket. ----------------------------------------------------------------- MRI Predicts Aggressiveness of Cancer ScienceDaily (Mar. 25, 2008) -- Magnetic resonance imaging (MRI) findings in patients about to undergo radiation therapy for prostate cancer can help predict the likelihood that the cancer will return and spread post-treatment, according to a new study. "This is the first study to show that MRI detection and measurement of the spread of prostate cancer outside the capsule of the prostate is an important factor in determining outcome for men scheduled to undergo radiation therapy" . . . http://www.sciencedaily.com/releases/2008/03/080325083338.htm --------------------------------------------------------------- Leah New on my blog: What to tell people if you have to take time off from work, faith, penile rehab, couples with cancer and stress, etc. > Yes, I know. MRI seemed less detrimental. Don't even know > what color doppler uses. If you have a metalic implant, you can't have an MRI. The magnets would RIP the implant out of your body. Remember the story 2 or 3 years ago about the 9-year-old boy who was killed when the MRI grabbed a fire extinguisher and hurled it at this head? ___ Blue Wave/QWK v2.12 |
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