Video: Finding a Quality Image Center for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

Alex: So, we have centers all across the country that do 3T MRI, so is the right thing for the patients to do if they want to know that they're gonna get a good center, is the right thing to call and say, you know, "How many have you guys done? How long has the doctor been in practice?" You know, is that kind of the questions they should be asking? 

Dr. Scholz: I think it's really hard for a patient to sniff out whether quality work is being done. I think they'd be much better served by going to some of the flagship centers that we know: UCLA, Memorial Sloan-Kettering, Cornell, UCSF—and that's the safest approach because so much is riding on getting trustworthy information and you don't really want to have any chance that you're getting a substandard read. So, it's hard for me to know if someone has an MRI done at some unknown center whether to trust it. I can look at the report and see if it's a professionally written report, but often what we'll do is we'll request the images on a disc and then we'll send it off to a reference center to be reread. They can look at the image quality—"did they do the scan properly"—and then they can reread the images and see if it matches what the report was originally from the center, and that's the safest thing to do. I don't know that patients are going to be able to—in fact, I, myself, really can't tell if these people know what they're doing until we cross-check it. 

Alex: So, can patients go ahead and send their records to a different place in order to get them checked? 

Dr. Scholz: I believe so, yes. It might take a little bit of legwork. You have to call the radiology department at one of the more prestigious centers and ask how we can get a second opinion and there's probably a mechanism that can be accomplished. 

Alex: So, one thing that I see often, again on helpline, but I don't hear it talked about with a lot of doctors is the endorectal coil otherwise known as the corncob, unfortunately, that men have to endure a lot of times when they're doing these 1.5 and I've even hear it with 3T. That's obviously very uncomfortable and I've heard from a lot of different doctors, not necessarily necessary. So, is it necessary? Are there cases where it's necessary so they can get a clear image maybe if there's metal in the pelvic area from any sort of military experience? 

Dr. Scholz: Yeah, so we practically never request endorectal coils. That was—five years ago we would use an endorectal coil. So, are there exceptions? The surgeons like to do them because they say they get a little bit more clear picture of the capsule and if they're thinking, "well, I don't want to operate if the cancer is through the capsule" then maybe you request an endorectal coil. As you know, my stance is that I wouldn't do surgery on my worse enemy, so I'm not for requesting endorectal coils under any circumstances. There is one exception for doing 1.5T MRIs. When people have had hip replacements, that metal from the hip is very close to the prostate and it causes all kinds of distortion when you use a really powerful magnetic field, and so sometimes it is possible to get reasonably good images with a 1.5T in people that have had hip replacements, but that is really the only setting where I would think about doing a 1.5T and in those patients, we don't do endorectal coils either. 

Alex: When it comes to PSMA scans in people who have had hip replacements, does the PSMA scan have a magnet? Will they just be able to get it as a normal body scan? 

Dr. Scholz: That won't be a problem. The PSMA PET scans are more like our historical nuclear bone scans, so it's not going to be done in an MRI unless it's one of these newfangled PET MRIs that I mentioned Dr. Margolis is doing research with at Cornell. So, that shouldn't be any problem at all. 

Alex: So, what other types of scans should patients in these types of categories—maybe advanced prostate cancer—look at? You know, bone density, heart scans, you know, obviously when we talk about prostate equals heart health, you know, we want to make sure that we're looking at the whole body. 

Dr. Scholz: Yeah, so, I think that the third category of scans that we utilize a lot in the prostate cancer world is more related not so much to advanced disease, but it's related to the fact that men with prostate cancer live decades and since they're in a more advanced age population, they're at higher risk for heart disease. So, we'll do CT scans of the coronary arteries to see if they have excess plaque. We know that response to statins and diet and so otherwise the problems with hardening of the arteries is a totally silent process. People don't really know. They look at cholesterol and family history and try and guess, but now that we have technology that can scan the coronary arteries, we do that pretty routinely in our patients. You mentioned bone density. That might be something that is more applicable to advanced disease because men on hormone therapy lose calcium from their bones. So, these are simple scans. They can render useful information about how strong the bones are. 

As people get older, they lose calcium. If they have to be on testosterone inactivating pharmaceuticals they will also lose calcium more quickly and a bone density scan can reveal if there's a need to go on some sort of therapy. Now, sometimes people confuse bone density scans with bone scans, and they are not a crossover. A bone density scan isn't going to tell you if there's any cancer present and a bone scan isn't going to tell you if osteoporosis is present. So, you have to do two different bone scan type procedures to get the information you need.