0:01

So why MRI?

0:02

We've discussed in prior vignettes,

0:05

surveillance is one of the primary

0:07

indications for MRI, especially in

0:09

individuals with the lower tier of disease,

0:13

which is again divided up into three tiers.

0:16

So let's talk about what those three tiers are.

0:20

You can break it down into three basic

0:24

categories that determine whether you're

0:27

in tier one, tier two, or tier three.

0:29

So let's start with tier one.

0:32

In tier one, And I'll put the number 1 up here.

0:36

The PSA is going to be 10 nanograms per mL,

0:42

which should be an N, nanograms per mL or

0:45

less, or 10 micrograms per liter or less.

0:50

The Gleason score should be 6 or less.

0:55

The clinical T category is

0:57

going to be T1C and T2A.

1:01

You don't know what those are?

1:03

That's what Google is for.

1:05

All right.

1:06

Let's look at tier number 2.

1:09

Let's get my, actually I'll leave

1:11

everything on here and we'll go to tier 2.

1:13

We'll use a different color.

1:14

Let's use blue.

1:17

Alright, so tier number 2.

1:20

The PSA level is going to be between 10 and 20.

1:26

Not going to repeat the units,

1:27

just to save you some time.

1:29

The Gleason score is 7.

1:32

And the T category is going to be T2B.

1:39

T2B, by the way, does not qualify for high risk.

1:43

Let's go to tier number three.

1:46

Tier number three, let's

1:47

pick a color that we like.

1:49

Oh, let's go with bright green.

1:51

Tier three.

1:53

The PSA level is greater than 20

1:57

nanograms per mL, or micrograms per liter.

2:00

The Gleason score is 8 to 10,

2:04

as you might have expected.

2:06

And the clinical T category is T1.

2:13

So, it's this red group, tier number one,

2:17

and perhaps a small subset of tier number

2:20

twos that are candidates for MR surveillance

2:23

with either a diagnostic MRI or, as we'll

2:27

see, a screening MRI which takes less than 15

2:30

minutes and is equally accurate in detecting

2:33

aggressive cancer as a diagnostic MRI.

2:37

We'll have a look at those later.

2:39

Thanks.