Answers for Men concerned about
or diagnosed with Prostate Cancer

Questions and Answers

Q. I called my local hospital to schedule my MRI as directed by my physician and the earliest appointment is in two weeks. I want to have my scan done sooner. Can you help?

A. Yes, we can normally schedule most exams the same or next day. We are happy to accept your doctors script to perform the exam as requested. In most cases, results are sent to your doctor by the next business day.

Q. I read that it can cost a lot more having a scan at a hospital compared to an outpatient facility such as yours. Can you explain?

A. Most hospitals will have significantly higher out of pocket costs to the patient compared to Partners Imaging. In addition, the fees that hospitals charge are not always transparent or easy to determine. There are often separate fees and bills from the hospital for the equipment, facility, materials, etc. and other fees and bills from the radiologist interpreting the exam or performing a procedure. A recent survey of hospital and outpatient fees found that when all costs are included, it may cost 10 times or more for the same exam or procedure at some hospitals compared to facilities like Partners Imaging. At Partners, we are committed to offer single, all inclusive low fee rates to our patients that will be paying out of pocket. You can do your own comparison by calling the hospital to determine the total costs of your exam. Then, call our insurance experts at Partners Imaging to determine what you will be paying, with or without insurance. You will be surprised at the difference.

Q. My doctor has ordered an MRI for me and provided me with a script that is directing me to a facility other than Partners. I found out that I will be scanned on a 1.5T MRI and I would prefer to be scanned on a more powerful 3T MRI since I want the best possible images of my condition. Can you accept his script?

A. Yes, we would be happy to accept your doctor's script to perform the requested exam. Prompt results will be sent to your physician. It is common for your physician and his office staff to direct you to an imaging center owned by the same group or hospital that your doctor works for. Unfortunately, while this may benefit your doctor's group, it may not be the best choice for you. As we know, not all imaging exams are the same. There are significant differences in cost, equipment, protocols, and the radiologist that will be interpreting your exam. As a patient, you have the right to choose where you want to be scanned. We hope you choose Partners Imaging for all the right reasons. Simply call our center at 941-951-2100 to schedule your exam. You can fax your script to us or bring it with you on the day of your exam.

Q. My husband is healthy 76 years old. After prostate surgery his PSA was below 0.1 ng/ml but in January this year, almost 2 years after surgery, his PSA went up to 0.18 ng/ml in Sept. and presently to 0.32 ng/ml. Our oncologist and our surgeon feels that at this point there is no study to detect where is the recurrent CA due to small value of PSA and most likely the small amount of cells present. The post operation pathology report indicated negative margins and negative lymph nodes. Do you feel that there is any place for a multiparametic 3T MRI at this point prior to Radiation Therapy?

A. Unfortunately, the problem you describe for your husband is not too uncommon post prostatectomy and implies treatment failure with recurrent disease. It is important to try to determine if the recurrent disease is local (i.e. in or around the prostate bed) or distant metastases. This will help determine the best treatment options. Your husband's PSA has slowly increased (less than a 0.2 ng/ml increase from Jan to Sept. of this year) which suggests, although is certainly not diagnostic, of recurrent local disease. The PSA is still very low so there is likely very low volume or microscopic disease present. It is difficult with any imaging method to detect this level of disease. We have done many multiparametetric 3T MRI prostate exams on patients following radical prostatectomy and other treatments that have a slowly rising PSA with detection of very low volume recurrent local disease. There are other studies that have shown similar results. I agree that it will be difficult to detect recurrent disease for your husband given the current low PSA level. However, I would recommend a properly performed and interpreted multiparametric 3T MRI to try to localize recurrent local disease. If this can be detected, your husband's disease may have a more favorable outcome and with less complications with targeted treatment.

Q. I am 38 years old. I was diagnosed with prostate cancer after a Biopsy in 2013. Gleason was 6 and PSA 6.8 ng/ml. I decided to go for “Active Surveillance” and change my diet with natural-alternative options. I have had 3 transrectal ultrasounds which have some incongruencies. I would like to get a better and more precise test that can tell me which is my actual situation. Can the Mp 3T help me !

A. A 3T Multiparametric MRI scan is recommended in your case for several reasons. The scan can determine whether you have clinically significant disease, and if so, the location and level of aggressiveness of the tumor (i.e. grade). Increasingly, Urologists are obtaining a 3T MRI prior to biopsy to help localize a potential cancer and to help guide or target their biopsy. This provides for a better sample of tumor and helps target the most significant or highest grade tumor. This information is essential in planning the proper therapy. A random TRUS biopsy performed without a prior MRI scan will miss up to 30% of significant cancers. This is possibly why you have some doubts about your prior ultrasound results.

Q. Is elevated PSA covered by Medicare as an accepted reason for calling for the test?

A. Yes, Medicare and most insurances will cover the cost of an MRI of the prostate for an abnormal, elevated PSA. You can call us at 941-951-2100 to verify if your particular insurance will cover the exam.

Q. I have a pacemaker implanted. Can you do a multiparametric MRI with a pacemaker?

A. No, unfortunately, we are unable to perform a 3T MRI scan on patients with implantable pacemakers. There are other contraindications that we screen for prior to scheduling an exam.

Q. I am in a watchful waiting mode having been diagnosed with Gleason 3+3 or 6 and a -1 Prolaris test score in Jan of this year. The Biopsy was ordered after a nodule was discovered on a DRE. PSA is Normal at 0.6 ng/ml. I am leaning towards surgery but would like to make sure there are no other factors. My Urologist has suggested the MRI but directed me to a place that requires the rectal probe. I understand that your MRI equipment is a later generation 3T that does not require this probe and could also provide better resolution and additional diagnostic tests of the prostrate. Can you confirm this and would you recommend this approach in my case

A. There are varying opinions in the use of an endorectal coil for an MRI of the prostate. We have it available on request and I will use it sometimes for special re-staging of post radiation/ surgery patients. For the first few years of our program, we used it on all patients. However, our experience is similar to many other facilities where we realized that there is a trade off of the added signal from the coil versus the image artifact and prostate distortion that often results. In addition, in some men it is uncomfortable and may result in bowel spasm or involuntary movement that can degrade image quality. At 3T and with pelvic coils of the type that we have at Partners, the signal is already so strong that the ER coil is not really necessary for most exams. We have found that our image resolution, as well as the signal enabling us to perform very rapid high resolution imaging following contrast administration (temporal resolution) and the better information we receive for other parameters such as Diffusion Weighted Imaging and Spectroscopy, is still superior and diagnostic on our system, without the problems that the coil can cause. Many facilities will continue to use the ER coil especially on 1.5T or lesser MRIs or with less adequate pelvic coils.

Q. Do you have the equipment/software/expertise to obtain an accurate image loooking for prostate cancer for a patient that has had a hip replacement?

A. Some hip replacements may cause a problem for an MRI of the prostate, particularly if they are bilateral and have large metal components. Other times they may cause artifact but do not affect scan quality for detecting prostate cancer. We usually cannot predict with certainty in advance which prostheses will be a problem since it also relates to the patient's anatomy. The same prosthesis for one patient may be fine and for another may significantly limit the scan. For this reason, we will at least attempt to do the scan with patient's that have a hip prosthesis and we'll know after initial imaging whether the scan will be successful or not. I can say that we are able to obtain a good quality, diagnostic scan in the majority of patients that have hip prostheses. Given the type of prosthesis you described, I would guess that your scan should be successful since it has a relatively small metallic component.

Q. I would like to obtain a 3T MRI of my prostate. What do I need to ask my physician or urologist to obtain an order?

A. You can download the script here and present it to your physician or urologist who will sign it. Alternatively, you can ask them to provide you with a script for an MRI of the prostate.

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