Waiting for an MRI

[dango27]

Hi all, first time poster. Been reading through the site and forums and really appreciate the all the info posted.

I'm 27 and currently living in Japan but I'm from the US, so my experience might be a little odd due to the Japanese health care system. If anyone has had any experience with the healthcare system here, any information would be really appreciated . I've read that in Japan survival rates for TC are lower than in the US, but I think it's probably due mostly to a really low rate of occurence in the population and thus less emphasis on early detection. I'm due back to the States in the autumn, so at the moment I'm mostly concerned about diagnosis and surgery.

At the beginning of March I was doing my self-exam and found a small hard spot on my left testicle just below the epididymis; felt like it was about the size of a grain of sand or a pinhead, and as far as I could tell it didn't move around. Somedays I couldn't find it and on others it was really noticeable. About 3 weeks ago it was still there so I went to see a urologist. He felt around for it and wasn't able to find anything, and he also performed an ultrasound which he said turned out clear. Just to make sure he ordered a blood test to check for tumor markers.
About a week ago we went over the results of the blood work and it turned out that AFP and LDH markers were in the normal range but the HCG-beta marker was elevated (0.7ng/mL as opposed to 0.0-0.1ng/mL). He also did an ultrasound of my lymph nodes and those turned out to be clear.

Because of the elevated HCG levels he suggested an MRI scan, but the next available opening is a month away (in Japan MRIs are relatively cheap and widely used).
My question is what is an appropriate amount of time to wait around for an initial diagnosis? Is it normal to wait a month or longer? Is there danger of metastasis occurring (if it hasn't already) in the month I'm waiting for my MRI? The waiting around not knowing anything is really making me all tense.

Thanks!

[Scott]

I'm used to seeing beta-hCG reported in mIU/mL rather than ng/mL, and I don't want to risk converting incorrectly. I'm uncertain whether the level reported suggests cancer, is a false positive or lab error, or may even be normal (though I assume not since it's above the normal reference range for the lab).

What would your doctor think about a follow-up blood test?

[TCdoc]

Hi,

I agree with Scott that the raised beta HCG is the only real sign that there could be an underlying TC. I would want to be reassured that either it was within the normal range or a false positive. Personally I would want a follow-up blood test.

The symptoms that you describe could just be a testicular microlith (small area of calcification) which is often missed or difficult to see on an ultrasound. I'm not sure if an ultrasound of your lymph nodes is of any value whatsoever in the era of CT scanning.

[ukboyuk]

I presume the MRI will be for your abdomen?

There is some research looking into whether MRIs are as good as or better than CTs, in order to not have the risks from exposure to radiation.

Grain of sand or pinhead? I'm amazed they can even spot that on the ultrasound, but I'm no radiologist. I'm thinking that TC education can sometimes make us go overboard in our "checking" - and you may simply be feeling a tiny imperfection or something.

I doubt you have TC. Even if you do and we assume this small speck is a tumour, it's got to be incredibly early stage. I can't see any harm from a month's delay.

As for Japanese healthcare, search the forum - I know of at least one chap who had chemo in Japan that I remember.

[Scott]

As for Japanese healthcare, search the forum - I know of at least one chap who had chemo in Japan that I remember.

Most likely this one.

[Aegean]

I would get the bloodwork done again. It does not sound like TC, particularly if the ultrasound did not pick it up. I may also consider another ultrasound at a different place, for the sake of comparison.

[Kiwi]

Have you had an Ultrasound of the Testicle yet?

Cheers

Kiwi

[dango27]

Thanks everyone, for all of the replies; I really appreciate it. Also, thanks for the link to the post about chemo in Japan. It was very helpful and addressed a lot of concerns I had about health care here.

My understanding is that the MRI is to get a more detailed look at the testes to make sure that the ultrasound didn't miss anything. The lump is small, definitely not 'pea-sized' or larger (under 1cm across) but still readily noticeable to me. Although the urologist was barely able to feel anything and couldn't find it on the ultrasound, he was concerned enough about the beta-HCG levels to order the MRI. He said that if it turns out that the MRI shows nothing there, then he'd need to do more tests to determine what's going on. The lab work took a couple of weeks to get in so it probably wouldn't get in much sooner then the scan.

I guess I'll just try to keep a calm head about things and not fret about it too much.

[Fed]

Ultrasounds are the gold standard for detecting solid testicular masses. I just don't see how much one could gain with an MRI.

[ukboyuk]

I guess with our friend detecting something but the ultrasound not showing anything, they are just using more investigative tools.

I have read before of MRI being done in addition to ultrasound for guys with only one testicle where they want to be absolutely sure before making any decisions to operate. But this is normally for when an unknown mass is detected on the ultrasound (a bit like my own case and the few others, where I did not know it was cancer - is that something like 10% of cases? I forget) rather than when nothing turns up on the ultrasound.

Maybe with MRI being so cheap in Japan that helps, I'd bet that many Western doctors would refuse it (apart from his word, there's no reason to get one, and our minds can play tricks on us) and at most tell the patient to return in a month for another ultrasound and blood tests.

[dango27]

Just a brief update. Went in for the MRI on Wednesday. Was my first time in one of those machines, but besides a ton of noise and a rather large looking injection it was no sweat. Find out results on Monday so fingers-crossed...

It did end up being rather affordable - I ended up paying around $115 in yen to cover the 30% patient copay under the national health insurance system (govt covers the rest I think). The scan was only about $40 or so more than the blood work. Go figure...

[dango27]

So got my scan results back. The MRI turned out clear; no abnormal masses shown on the testes. The urologist was still stumped about the tumor markers, so he also ordered an abdominal CT scan to check for extragonadal tumors, but that turned out clear as well. So all in all I'm feeling good about the results, and won't have to undergo any surgery for now. There's still the nagging issues with the HCG-beta marker and the small bump (although I'm more inclined to feel that it's a cyst or vein or something the more that I've been poking at it).

Since there's no imminent danger apparent, the urologist recommended observation and that I get it checked again when I get back to the States.

Thanks again to everyone that offered info and advice. This site and this forum does a really great service in terms of putting one's mind at ease.

[Hiro of War]

I have the same sort of bump as you, very small bump just below the epididymis, and it can only be really noticed after a hot shower. However, when I lightly squeeze the epididymis, its almost as though i can just barely pick it up, off the testicle it self. I am however too nervous to get a new gp hahaha.