Prostate Cancer Treatment
There is no universally agreed upon “best” prostate cancer treatment. Treatment recommendations often vary based on where you live and which urologist you meet with. Most experts around the world believe that we are experiencing an epidemic of prostate cancer over treatment. Your ideal prostate cancer treatment will be the one that fits YOU best! The Scionti Prostate Center does NOT believe in a cookie cutter, “one size fits all” approach. While HIFU is a revolutionary treatment that offers patients a minimally invasive treatment with a low risk of side effects, not all patients are candidates for HIFU treatment. Obtaining an accurate diagnosis is the first step in selecting any prostate cancer treatment.
Prostate cancer diagnosis at the Scionti Prostate Center begins with a multiparametric MRI of the prostate. If the MRI reveals a suspected tumor, then an MRI Fusion Guided targeted prostate biopsy is performed. This 'smart" or targeted biopsy technique is more accurate in detecting and characterizing prostate cancer than the old fashioned, ( archaic) TRUS guided or blind prostate biopsy.
Several cores of prostate tissue are extracted from the prostate and sent for laboratory analysis by a physician who specializes in Pathology. This is the most critical component in identifying the cancer and planning treatment.
The truth about prostate biopsy:
- Many patients are fearful of a standard or TRUS guided, blind prostate biopsy because they have heard that it can have up to a 40% rate of false negatives leading to repeat biopsy (TRUE). MRI Fusion guided targeted prostate biopsy is the most accurate way to detect a prostate cancer, and greatly reduces need for repeat blind prostate biopsies.
- Prostate Biopsy is very painful (FALSE) Dr. Scionti administers an ultrasound guided precision prostate nerve block that makes the targeted biopsy procedure painless.
- Prostate cancer can be accurately diagnosed and graded for aggression by MRI alone (FALSE) The cancer cells must be studied under the microscope and often times by genomic analysis to obtain an accurate diagnosis. Even the best imaging with the best radiologists can lead to mistakes in treatment. MRI is extremely valuable, but MRI does not detect 100% of all prostate cancers, and not all MRI abnormalities turn out be prostate cancer.
- Accurate diagnosis of your cancer (accurate stage, grade, genomic analysis if necessary) as well as 3D location in the prostate is needed for personalized treatment planning.This is especially true for any focal (targeted) treatment where some prostate tissue is being left untreated. (TRUE)
The Scionti Prostate Center Approach
Step 1: Advanced Accurate Diagnosis:
Know Where Your Cancer Is: MRI Guided Fusion Targeted Prostate Biopsy : Dr Scionti uses ARTEMIS technology to fuse (or co-register) high-resolution magnetic resonance images (MRI) with real-time ultrasound. The Artemis fusion system allows for an in-office precision biopsy targeted to MRI abnormalities. Artemis fusion biopsy provides the most accurate diagnostic information because the most significant tumors in the prostate, well seen by MRI, can be accurately targeted and sampled providing a much better understanding of the true nature of a patient’s prostate cancer. The ultrasound guided prostate nerve block administered by Dr Scionti allows the Artemis Biopsy procedure to be done without pain in our center.
Detailed Laboratory Information About Your Cancer: When prostate cancer is diagnosed, three clinical indicators (PSA, Gleason score, and clinical stage) are used to determine a patient’s risk level. The most common classification system is called the D’Amico system:
Low risk – PSA 10 or less, Gleason score 6 or less, Stage T2a or less
Medium risk: 2 of these factors: PSA >10, Gleason score >6 , Stage T2b or higher
High risk: all 3 of these factors: PSA >10, Gleason score >6 , Stage T2b or higher
However, the challenge with assessing risk in this manner is that it may not be sensitive enough. Accurate information on the size, shape, exact location and tumor DNA (genomic information) is key to accurately assessing the risk of a prostate cancer. Today, more than 85% of newly diagnosed patients are considered low-or intermediate-risk. That’s the problem. Many patients have similar clinical information and can often appear the same when in fact they are very different. One patient might have a slow growing cancer that will never be a problem and the second patient might have a more aggressive cancer. Dr. Scionti believes that the treatment needs to be selected according to the true aggressiveness or nature of the cancer. Your prostate cancer is not the same cancer found in your neighbor, best friend or anyone else you know who was diagnosed. New genomic testing of the tumor cells with a test such as the Genomic Health GPS test or Decipher biopsy score gives us a better understanding of the cancer and helps him to customize treatment recommendation.
Step 2: Treating Prostate Cancer with a Personalized Treatment Pathway
The advanced diagnostic techniques outlined above are used to design a personalized treatment program. Dr Scionti is the leading expert in the field of prostate ablation with HIFU, but not every patient is a candidate for HIFU treatment.
Prostate cancer can be monitored with active surveillance, or can be treated radically by prostatectomy or total gland radiation therapies. These apporaches can be appropriate for some patients. However, MRI fusion Guided HIFU ablation of either the entire prostate or only the cancerous portion or the prostate is a noninavsive high-tech apprioach to treament that can preserve urinary and erectile function.
The Scionti Prostate Center has develppoed the most advanced HIFU treatment technique in the world. The Scionti MMM (Triple M) HIFU treatment uses MRI images, combined with targeted biopsy information to MAP the tumor location within the prostate gland. This Map is then incorporated into the HIFU treatment device allowing a highly personalized HIFU treatment plan to be designed. The HIFU energy can be Modulated (adjusted) so that the tumor region of the prostate recieves a much higher dosage of focused ultarsound energy than the neighboring areas resulting in more effective ablation and fewer side effects.