Prostate Cancer Treatment

Prostate cancer is not a single disease that behaves the same in all patients. The standard of surgical removal of the entire gland (radical prostatectomy) has been replaced by an array of effective, minimally invasive techniques. For appropriate patients, I have long been committed to treatment by ablation, or tumor destruction without surgery. My own experience with HIFU and cryotherapy, and careful analysis of published data have shown that proper patient selection is the key to ablation success and high quality of life after treatment.

Since each case of prostate cancer is literally unique to each patient and his lifestyle, it is essential that the biopsy method detect and target the precise areas of the walnut-size prostate gland from which to extract tissue samples for in-depth laboratory analysis.

When I conduct a prostate biopsy, I use a state-of-the-art imaging technique that fuses ultrasound with MRI (magnetic resonance imaging). The technology, called Artemis, offers accurate biopsy guidance and minimizes the uncertainty of the conventional 10-to-14 prostate needle biopsy guided by ultrasound alone. In many cases, fewer samples need to be taken.

Together with the lab work, I can thus match appropriate treatment choices with the needs of the patient. This especially benefits patients with low-volume, low-risk disease in deciding, for example, if they wish to participate in active surveillance or seek a customized ablation as an alternative to radical prostatectomy.

Research affirms that adding MRI to ultrasound can produce a 3-D image that locates suspicious activity in the prostate more clearly than ultrasound alone. While a 2002 report suggested the potential of this method , a recent study found a significant difference between the accuracy of the fusion technique vs. that of the conventional systematic biopsy guided by ultrasound alone.

The study results were presented on May 9, 2011 at the International Society for Magnetic Resonance in Medicine (ISMRM) 19th Annual Meeting and Exhibition. According to one of the study authors, Dr. Daniel Margolis, "While other major cancers can be imaged within the organ of origin, the small, compact prostate has proven elusive for a number of reasons, such as the similarity of cancer and benign tissue and the lack of tissue uniformity."  He stated, "MRI-ultrasound fusion targets additional cancers, compared with systematic biopsies, and may replace systematic biopsies - resulting in fewer total biopsies, improved yield, and improved confidence for patients with a small amount of low-grade cancer who opt for active surveillance."

The imaging fusion technique differs from the conventional biopsy. Currently, most doctors use a systematic biopsy guided by ultrasound alone, which produces a two-dimensional image. Since prostate cancer is considered a multi-focal disease, a predetermined sampling of areas on both sides of the gland is assumed to capture cancer cells. However, this method sometimes misses cancer and results in a negative biopsy even in men with known risk factors.

"We are hindered by our blindness in looking at prostate cancer," said Anwar Padhani, MB, BS, FRCP, FRCR, moderator of the ISMRM session, who is honorary senior lecturer at University College, London. "Systematic biopsies are nontargeted and so lead to underestimates of tumor aggressiveness and tumor staging. The multiparametric approach is clearly the way to go if we are going to improve men's health in the future," he said.

The biopsy technology used by the researchers is the same equipment that I use. For all of the significant reasons cited by the study authors, I am proud to be able to offer this 3-D precision biopsy method to my patients. Working together, they and I have a high degree of confidence that their treatment decision meets both of our goals in choosing the treatment that's right for each of them.