PSA test

[NancyL]

1 hour ago, LOUIS65 said:

I forgot to add that there is absoloutly no anaesthetic for the 4,500 baht Biopsy at the Maharaj Nakorn Hospital. I felt very sorry for the poor guys queing up for an appointment for the biopsy and who  probably had no idea  what they were letting themselves in for, nor the risk factor of infection.  

You can't emphasize this enough.  No anesthetic.  Hubby had a high PSA reading a few years ago and a urologist at one of the top private hospitals in Chiang Mai wanted to do a biopsy without anesthetic.  Can't name names for the same reason you mentioned.  Needless to say, he did some internet research and went down to Bumrungrad hospital.  Now that Bangkok Hospital-Chiang Mai is opened, he doesn't have to put up with this nonsense and can get good treatment closer to home.  

 

His biopsy was clean, but once again his PSA readings are high.  Note how I said readingS.  Can't stress enough the importance of getting at least two readings before doing anything drastic like a biopsy.  In his case, he waited two months just to see how much the number to would increase and it pretty much stayed the same.  The urologist at Bangkok Hospital - Chiang Mai recommended a MRI and it showed enlargement in the same area where enlargement was noted five years ago at Bumrungrad.  

 

We've decided against a biopsy and instead will go with PSA readings every 3 months.  After a certain age, many men have prostate cancer, but they die of other causes.   After age 70, the medical community has mixed opinions about treating for prostate cancer.  Personally, I'm glad we have the money available for Hubby to be tested every 3 months and to have an ultrasound or MRI if the number goes higher to see if the "enlargement" is getting bigger.  

 

There are certain dangers in doing a biopsy.  Like rectal perforation.  Like spreading what had been an "encapsulated" cancer elsewhere in the body.  And, the clean-out procedure to get ready for the biopsy isn't pleasant and the next day or two afterwards is down-time also, especially in Thailand's heat.  

 

All this being said, in my activity of assisting older expats with medical problems in Lanna Care Net, I've helped some men who had prostate cancer that they decided not to treat.  It's not a good or quick death.  The cancer spreads to the bones of the hip, pelvis and spine, is painful and robs the man of the ability to walk or even turn himself over in bed.  Any dreams of "dying at home" are shattered because your family doesn't have the equipment or strength to take care of you.  Thus, the importance of having PSA tests and other tests like ultrasounds and MRI to see what's going on if you're like my husband and have decided not to have biopsies any more.  

[Dante99]

Nancy, where do you or would you go for hubby's prostate MRI, doctor's name, and what is the approximate cost?

[elektrified]

2 hours ago, Dante99 said:

Nancy, where do you or would you go for hubby's prostate MRI, doctor's name, and what is the approximate cost?

Dante there is nowhere in Chiang Mai that offers Prostate MRI Tesla 3. Suan Dok offers MRI - T 1.5. But you could go down to Phitsanulok to Pitsanuvej Hospital where they often have promotions. That is the only place in the North that offers T3 MRI. Other than that it's one of 2-3 hospitals in Bangkok. Approximate cost in Phitsanulok is about 13,500 when on promotion.

[elektrified]

6 hours ago, LOUIS65 said:

........I hope this helps others out there. Thank you for all the lovely messages I have recieved. 

I would not wish this diagnosis on anyone.  

 

 

As I understand it, you did not have a diagnosis - did you?

[Dante99]

10 hours ago, elektrified said:

Dante there is nowhere in Chiang Mai that offers Prostate MRI Tesla 3. Suan Dok offers MRI - T 1.5. But you could go down to Phitsanulok to Pitsanuvej Hospital where they often have promotions. That is the only place in the North that offers T3 MRI. Other than that it's one of 2-3 hospitals in Bangkok. Approximate cost in Phitsanulok is about 13,500 when on promotion.

Thank you very much for that information.  Do you know if the Pitsanuvej Hospital does the multiparametric MRI?

[CM4Me]

On ‎24‎/‎03‎/‎2018 at 11:29 PM, elektrified said:

Dante there is nowhere in Chiang Mai that offers Prostate MRI Tesla 3. Suan Dok offers MRI - T 1.5.

What is the difference between MRI Telsa 3 and MRI T1.5?

[Dante99]

6 hours ago, CM4Me said:

What is the difference between MRI Telsa 3 and MRI T1.5?

I think it is about the power of the machine used, the 3 being a more powerful machine and creating better images.  

[elektrified]

On 3/25/2018 at 11:45 AM, Dante99 said:

Thank you very much for that information.  Do you know if the Pitsanuvej Hospital does the multiparametric MRI?

Honestly I'm not familiar with that procedure and have not seen it mentioned in the many threads on prostate MRI in the health forum.

[elektrified]

On 3/26/2018 at 6:20 AM, Dante99 said:

I think it is about the power of the machine used, the 3 being a more powerful machine and creating better images.  

Yes, that's it exactly. Much higher resolution imaging.

[tigerbeer]

without reading the the whole thread, one would skip mri or psa tests if a colonoscopy came out clean?

[bkk6060]

35 minutes ago, tigerbeer said:

without reading the the whole thread, one would skip mri or psa tests if a colonoscopy came out clean?

???

Colonoscopy has nothing to do with Prostate.

[Dante99]

5 hours ago, elektrified said:

Honestly I'm not familiar with that procedure and have not seen it mentioned in the many threads on prostate MRI in the health forum.

TV thread

 

How to avoid a biopsy to test for prostate cancer

By R123, January 20, 2017 in Health and Medicine 

 

post 54 and other posts by "bubba" talk about it, Sheryl mentions it in post 59

[elektrified]

15 hours ago, Dante99 said:

TV thread

 

How to avoid a biopsy to test for prostate cancer

By R123, January 20, 2017 in Health and Medicine 

 

post 54 and other posts by "bubba" talk about it, Sheryl mentions it in post 59

Thanks for that. I know that thread, just hadn't followed up reading it for a while. So learn something new every day...

 

Why not call the MRI Dept. at the hospital in Phitsanulok and see what they have to say? When I called and spoke with them I found them to be very helpful and knowledgeable (but I didn't know about this multi-parametric technique so didn't ask).  The MRI Dept. at Suan Dok recommended them to me because they said it is easy to schedule and do there. They said that if you go to Bangkok you have to go to either Chulalongkorn, Siriraj, or Bangkok General for Prostate MRI Tesla 3. Really that means Bangkok General unless you live there or can spend a couple of weeks down there because the other two options being teaching hospitals/government subsidy institutions require about 3 visits 1-2 weeks apart before the actual procedure to follow-up, process paperwork, etc.

[bubba]

One other thing to keep in mind regarding multi-parametric MRIs of the prostate is the skill and experience of the radiologist doing the interpretation. I have seen accounts of both false positives and negatives. If you are not certain of that, you might want to consider getting a second opinion from a radiologist who specialises in that. You can do that by requesting the imaging on a DVD (it's close to 4 GB) and then Dropboxing it to a highly qualified radiologist. I think we are not allowed to post forum links here, but you can google Dr. Joe Busch prostate MRI and find more information about that, as he is widely recognised as a highly competent radiologist who only does prostate MRIs. He also does in-bore MRI biopsies which are very targeted to finding the tumour with the fewest possible, but then he is in the USA and I believe Thailand does not have that capability in any hospital.

 

Only consider having a 3T MRI, as the resolution is much better at detecting smaller tumours. Another advantage is that with the increased power, an abdominal apron array is used. Generally with the 1.5T MRI, an endo-rectal coil is required, and with the procedure taking more than half an hour, that is uncomfortable to say the least.

 

Mutiparametric (MP) MRI means that several different parameters are examined, including a gadolinium contrast. Adenocarcinoma shows uptake of the gadolinium, which makes them much more visible to the radiologist if it is present, and hopefully it won't be! Both positive and negative predictive value is very good with 3T MP and a good radiologist, which can eliminate unnecessary biopsies in some cases.

[CM4Me]

I emailed 'Pitsanuvej Hospital' Phitsanulok re their MRI 3T and asked the following:

 

Do you have the capability and experience with multi-parametric imagining using a contrasting enhancer?

 

They replied:

 

We have a team of Radiologist, board certified and skilled in providing and performing MRI investigation with contrast. MRI Prostate with contrast is about 20,000 THB; without contrast is only 11,000 THB.

[elektrified]

8 hours ago, CM4Me said:

I emailed 'Pitsanuvej Hospital' Phitsanulok re their MRI 3T and asked the following:

 

Do you have the capability and experience with multi-parametric imagining using a contrasting enhancer?

 

They replied:

 

We have a team of Radiologist, board certified and skilled in providing and performing MRI investigation with contrast. MRI Prostate with contrast is about 20,000 THB; without contrast is only 11,000 THB.

It's actually a little more, but not all that much. They explained to me that there are some labs and other test required the day before the MRI or possibly the day of the MRI, which amount to around 2500 Baht.

[bubba]

Those lab tests are probably kidney function tests to ensure your kidneys are working right and can get rid of the gadolinium contrast agent without being damaged. There are newer formulations of the contrasting agent that do not require that.

 

Did you ask if they have 3T MRI?

 

As for the radiologists, I am sure they are good there, but I would still get a second opinion from a radiologist who has extensive background with prostate MRIs and specialises in that.

[elektrified]

5 hours ago, bubba said:

Those lab tests are probably kidney function tests to ensure your kidneys are working right and can get rid of the gadolinium contrast agent without being damaged. There are newer formulations of the contrasting agent that do not require that.

 

Did you ask if they have 3T MRI?

 

As for the radiologists, I am sure they are good there, but I would still get a second opinion from a radiologist who has extensive background with prostate MRIs and specialises in that.

They have 3T MRI. They are the only place in Northern Thailand with 3T MRI.

[Dante99]

5 hours ago, bubba said:

 

 

As for the radiologists, I am sure they are good there, but I would still get a second opinion from a radiologist who has extensive background with prostate MRIs and specialises in that.

Can you recommend somebody like that?  North of Bangkok?

[elektrified]

53 minutes ago, Dante99 said:

Can you recommend somebody like that?  North of Bangkok?

I think he means someone in Boston, MA or another International location that accepts the files over the Internet and will interpret them. That seems to be a popular method I've seen mentioned a number of times on forums that discuss prostate issues.

[bubba]

54 minutes ago, Dante99 said:

Can you recommend somebody like that?  North of Bangkok?

Your second opinion radiologist does not need to be local. I had posted this earlier in the thread here:

 

You can do that by requesting the imaging on a DVD (it's close to 4 GB) and then Dropboxing it to a highly qualified radiologist. I think we are not allowed to post forum links here, but you can google Dr. Joe Busch prostate MRI and find more information about that, as he is widely recognised as a highly competent radiologist who only does prostate MRIs.

 

So - once his office downloads your imaging files from Dropbox (or Google Files or whatever), Dr. Busch would review it and then schedule a call with you to discuss his interpretation and recommendations. He spends 45 minutes to an hour explaining everything in great detail and answering any questions you might have.

[CM4Me]

In my situation we have been monitoring my elevated PSA, had an MRI scan (on a 1.5 Tesla with contrasting agent) some 12 months ago, with the resulting impression ‘significant cancer is unlikely to be present’.

 

However, my PSA continues to rise, ever so slowly. As a result my CNX Urologist indicated at my last consultation that if my PSA continues to rise then we should have another MRI. My next PSA Test/ consultation are due late May’18. Hence my interest in the newer MRI.

 

On ‎3‎/‎04‎/‎2018 at 8:26 AM, elektrified said:

It's actually a little more, but not all that much. They explained to me that there are some labs and other test required the day before the MRI or possibly the day of the MRI, which amount to around 2500 Baht.

Electrified, may I ask when communicating with Pitsanuvej Hospital, Phitsanulok, with whom did you communicate, (ie International Customer Relations or the Radiologist Department)? The reason I ask is that I suspect the reply to my email enquiry came from International Customer Relations, was a general response and did not address my specific question, ie multi-parametric imagining. Thanks

 

[cheeryble]

Inside Health on BBC

A fantastic podcast all u need to know on prostate cancer 

 

http://www.bbc.co.uk/programmes/b09tdyk1

[GarryP]

53 minutes ago, cheeryble said:

Inside Health on BBC

A fantastic podcast all u need to know on prostate cancer 

 

http://www.bbc.co.uk/programmes/b09tdyk1

Thanks for the link. Very interesting. 

[elektrified]

On 4/5/2018 at 11:43 AM, CM4Me said:

In my situation we have been monitoring my elevated PSA, had an MRI scan (on a 1.5 Tesla with contrasting agent) some 12 months ago, with the resulting impression ‘significant cancer is unlikely to be present’.

 

However, my PSA continues to rise, ever so slowly. As a result my CNX Urologist indicated at my last consultation that if my PSA continues to rise then we should have another MRI. My next PSA Test/ consultation are due late May’18. Hence my interest in the newer MRI.

 

Electrified, may I ask when communicating with Pitsanuvej Hospital, Phitsanulok, with whom did you communicate, (ie International Customer Relations or the Radiologist Department)? The reason I ask is that I suspect the reply to my email enquiry came from International Customer Relations, was a general response and did not address my specific question, ie multi-parametric imagining. Thanks

 

Yes, the radiology dept.

[Dante99]

Pitsanuvej Hospital experience.  My wife spoke by phone with a nurse (not a radiology nurse but one who does paperwork and sends people to radiology) there about 3 times last week and the nurse had the International Customer Relations lady confirm the apointment by email after the first conversation.  I exchanged a few emails with them and the prices started at 13-14,000 and ended up at 18-20,000 with contrast which was the cost wild card.  I was to have an appointment with a urologist and then the MRI assuming no issues.

 

I went for my appointment yesterday.  Did paperwork, answered questions and signed a paper with their putting a price of 14,000 on it and no comment from me.  Then waited in 4 different locations, the final one being radiology.  After almost 3 hours total time there I was told that they could not do the MRI because they did not have a doctor to read and report on the results.  They asked if I wanted to go to an affiliate of theirs for an MRI the next morning which I declined, that would have been a T 1.5 machine.

 

Over many years I have had very few problems doing things here and am confident that there were no personal issues and no misunderstandings.  That they could not do the test and offered another venue and machine for the next day was confirmed by their phone conversation with my wife before I was told in person.

[elektrified]

2 hours ago, Dante99 said:

Pitsanuvej Hospital experience.  My wife spoke by phone with a nurse (not a radiology nurse but one who does paperwork and sends people to radiology) there about 3 times last week and the nurse had the International Customer Relations lady confirm the apointment by email after the first conversation.  I exchanged a few emails with them and the prices started at 13-14,000 and ended up at 18-20,000 with contrast which was the cost wild card.  I was to have an appointment with a urologist and then the MRI assuming no issues.

 

I went for my appointment yesterday.  Did paperwork, answered questions and signed a paper with their putting a price of 14,000 on it and no comment from me.  Then waited in 4 different locations, the final one being radiology.  After almost 3 hours total time there I was told that they could not do the MRI because they did not have a doctor to read and report on the results.  They asked if I wanted to go to an affiliate of theirs for an MRI the next morning which I declined, that would have been a T 1.5 machine.

 

Over many years I have had very few problems doing things here and am confident that there were no personal issues and no misunderstandings.  That they could not do the test and offered another venue and machine for the next day was confirmed by their phone conversation with my wife before I was told in person.

Wow, sounds like total disappointment! Sorry to hear that Dante. Like I said earlier, I was referred to them by the technicians at the Suan Dok MRI Dept. They told me that it was easy there in comparison to going to Bangkok. I made the initial contact but hadn't had a chance to get down there to have the MRI.

[Dante99]

8 hours ago, elektrified said:

Wow, sounds like total disappointment! Sorry to hear that Dante. Like I said earlier, I was referred to them by the technicians at the Suan Dok MRI Dept. They told me that it was easy there in comparison to going to Bangkok. I made the initial contact but hadn't had a chance to get down there to have the MRI.

I have no problems about your end or information or the Suan Dok MRI Dept.  I had some other things to do in Phitsanunlok and had not been there for some years so I enjoyed the trip.

 

 

[elektrified]

Any recent experiences on prostate MRI's?

 

I had planned on going to Pitsanuvej to get the 3T MRI but was hesitant based on Dante's experience. I spoke to my doctor the other day about it and he did not seem interested in an MRI from anywhere other than CMU or 3 locations in Bangkok. He said it is more important to have the T-1.5 technology performed by experienced radiology technicians and interpreted by qualified radiologists (like his colleagues at CMU) than new technology interpreted by radiologists he has never heard of before. That makes sense. He didn't even know Pitsanuvej had 3T MRI.

 

I inquired today at both Sriphat and Suan Dok which share the same equipment and same radiologists and technicians. Sriphat is 25,500 Baht and Suan Dok is only 2-3 thousand Baht less but with a 3-4 month queue. I believe that is with contrast dye.

 

I did overhear one technician say that Bangkok C.M. Medical Center offers prostate MRI (T-1.5). Has anyone had a prostate MRI there? If so, how was the experience and what was the cost?

 

Thanks.

 

[Vacuum]

I've heard/read that the only way to get a sure result regarding prostate cancer, is to do a biopsy (albeit it's like throwing darts blindfolded) So my question is what can they detect with these MRI-scans?