動画タイトル
MP-MRI Finding Inflammation | MRI with Hip Replacement | Mark Scholz, MD, PCRI (Prostate Cancer Research Institute)
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「問題提起」
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- 一人目の相談はどういう相談ですか？
- PCの発見に通常最も効果的な検査法、或いは組合せを選びなさい
- Multi-parametric MRI
- Targeted biopsy
- Random biopsy
- PSA
- X-ray
- CT
- a color doppler ultrasound
- Old vs Modern という点では？
- a flagship centerとは？
- 何のQuality controlが必要と言ってますか？
- overread とは？
- Random biopsy vs targeted biopsy どちらがよりスキルを必要とする？
- 医師のアドバイスは次の内どれ？
- 前回のMRIから６ヶ月しか経ってないから、PSA上昇でも一時的か見極める必要があるので、様子を見るべき
- MRIをもう一度受けるべき
- MRIのセカンドオピニオンを受けるべき
- 二人目の相談 どういうご相談ですか？
- 医師のアドバイスの内正しいのはどれ？
- A hip replacementした人はMRIは行えないからrandom biopsyしか選択肢がない
- 91歳にrandom biopsyでも問題ない
- 91歳なので緩和ケアを考えるべき
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Full Story
This next patient had a PSA of 4.0 and then a psa of 5.5 two months later.
They had anmpMRI with a PI-RADS 3
and then targeted biopsy that discovered inflammation but no cancer.
Six months later, their PSA went up to 10.0,
and they want to know what they should do;
should they repeat the biopsy? Or repeat the MRI?
We’re talking about someone that is beingevaluated in /what I would consider/
a more modern sense with an MRI rather than a random biopsy.
Historically, men have just gone around the clock
and had a dozen biopsies doneto make sure there was no cancer.
Back several years ago it was shown that MRIs are better at finding prostate cancer
and people are starting to substitute multi-parametric mri and targeted biopsy
for the old random biopsies so they don’t get stuck in the prostate so much with these needles.
The situation with a rising PSA, /I think,/ it just takes a fresh look.
It may be time to get another MRI.
Of course, you want to review where was the MRI done
and was it read by reputable people
since we’re putting so much reliance on the MRI
to make sure we’re not missing any cancer.
So, I would make sure that the MRI is done at a flagship center, consider repeating the MRI.
When people have a targeted biopsy they, again, that’s a skill,
and so they have to make sure
that the physicians that are doing the targeted biopsy are actually hitting the target.
So, this new technology, multi-parametric MRI, followed by targeted biopsy,
I think, is definitely a better way to go
but the quality control is essential
and people can have their MRIs sent for overread
at places like Memorial Sloan-Kettering or Cornell or UCLA
and make sure that they’re not missing something
and that they’re targeting the right area.
Those are the issues/ I think/ that need to be reviewed.
So this next patient is 91 years old and is taking testosterone replacement therapy.
His PSA was rising to about 13 when he was on the therapy,
but every time he gets off, it drops back down to one.
His testosterone is less than 200. He’s worried about getting biopsy
because of his age and he’s also had a hip replacement which precludes him from an mpMRI.
Do you have any other ideas of how he should check if he has cancer
because he wants to continue his life and is worrying about threatening it?
So first of all, can we deal with the hip replacement and the mpMRI?
Can he absolutely not get an MRI with a hip replacement?
So, if he goes to a center that has experience doing MRIs in people with hip replacements,
they’ll probably do something with a 1.5 Tesla MRI and make adjustments,
and they can get pretty good images.
You can also get a color doppler ultrasound
and look and see if they can find a spot that looks like it’s cancerous.
I would agree that a 90-year-old doing a random biopsy would be a risky procedure.
Targeted biopsies, where they just take one or two cores are pretty darn safe
in our own experience…we’ve seen essentially no infections over a five-year period just doing targeted biopsies;
the point being is that if he has a cancer that could be radiated and eliminated,
then he could safely go back on the testosterone if he felt that was important for his quality of life.
can you high-five me?
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