I came across a quote from Benjamin Franklin that caught my attention: "An investment in knowledge pays the best interest." I'm sure prostate disease was far from Ben's mind, yet his words carry weight as we go through life in business, love, leisure-you name it.
Investing in advanced prostate diagnosis pays off immensely. The prostate is a walnut-size gland tucked deeply among organs that affect a man's sexual, urinary and even bowel function. Nature has protected it well from external harm because of the key role it plays in manufacturing fluid necessary to move sperm out of the body. However, the prostate can quietly harbor internal harm. In the case of prostate cancer, it gives little warning, or sends out mixed signals.
The early whispers of prostate cancer may include a rising PSA (Prostate Specific Antigen) blood level, an abnormal digital rectal exam, and urinary symptoms. But they are not definitive pointers to cancer, so when routine screening detects one or more, patients have four options:
- Undergo a systematic, random 10-14 needle biopsy guided by grayscale ultrasound through the rectal wall (a TRUS or Transrectal Ultrasound biopsy)-in effect, a 3-dimensional grid of punctures with a hit-or-miss effect and up to 40% rate of false negatives;
- Search for doctors who market themselves as able to diagnose prostate cancer without a needle biopsy-which today's imaging equipment is actually not able to do, though suspicious tumors can be identified with high resolution MRI;
- Do nothing and hope that what's causing those whispers isn't cancer; or
- Advanced Prostate Diagnostics
Know Your Disease
Each year about 1.5 million core needle biopsies are performed, revealing about 220,000 new diagnoses of prostate cancer. A large Chinese study found that only 31% of surgically removed prostates showed the same Gleason score as the biopsy. The authors concluded, "The accuracy of Gleason scores determined by needle biopsy in patients with prostate cancer seems to be unreliable. Therefore, further evaluation of patients is necessary." As I've pointed out, imaging equipment alone is not sufficient to identify at the cellular level whether or not there's actually cancer. Or how dangerous it is if it's there. And the idea of repeating a TRUS biopsy must surely send a chill down the spine of many a patient.
Advanced Prostate Diagnostics
The key to success is taking diagnosis to an advanced level, beyond the "blind" TRUS biopsy. The best way to identify and evaluate exactly what's going on in each patient's prostate is to combine state-of-the-art imaging with a selective, or targeted, biopsy.
In my practice, I utilize an integration of the best imaging technologies: fusion of high resolution multi- parametric MRI images with sophisticated, real-time ultrasound (US). This MRI-US fusion is accomplished by the Artemis® device, which generates a 3D model of a patient's prostate showing precise tumor location, shape and size. Once a region of suspicion is clearly identified, I use a local anesthetic for the patient's comfort, and then take a limited number of direct samples guided by Artemis. It is much more accurate than the traditional TRUS biopsy. I am confident that I have captured cells from areas most likely to harbor aggressive disease, and that I have not missed any clinically significant disease.
An equally important aspect of Advanced Diagnostics is sending the tissue samples to an expert pathology lab for analysis using state-of-the-art cellular science. If the samples prove positive for cancer, I provide my patients with a detailed report, including color-coded images, and go over it with them. By then, I and my patient know his disease.
Match the Treatment to the Disease
A standard, random TRUS biopsy and a "no-biopsy" imaging diagnosis are both risky investments. All prostate cancers are not created equal! Each man's anatomy will have some unique features. Some men will be aggressively overtreated, resulting in an increased risk of urinary and sexual side effects. Others will be undertreated because the full extent or aggression level was underestimated; they may not lose function but may be at increased risk that the cancer will return, perhaps at a more dangerous level.
Would you be interested in a treatment choice tailored for you, with the greatest probability of cancer control, yet minimal impact on those delicate surrounding structures? Simply put, Advanced Diagnostics is your best investment in knowledge.