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 overtreatment. 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 and TULSA -Pro are revolutionary treatments that offer patients a minimally invasive treatment with a low risk of side effects, not all patients are candidates for Ultrasound ablation 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. If you have already been diagnosed with prostate cancer by a "standard" biopsy, you are still a candidate for HIFU treatment.
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 prostate cancer, and greatly reduces the 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 oftentimes 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 to be prostate cancer.
- Accurate diagnosis of your cancer (accurate stage, grade, genomic analysis if necessary), as well as a 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 and What Size 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: (Favorable: Gleason 3+4 or Unfavorable: Gleason 4+3 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 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 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 may give us a better understanding of the cancer and helps him to customize treatment recommendations.
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 ultrasound ablation with HIFU, but not every patient is a candidate for HIFU treatment. In January 2020, Dr. Scionti performed the first TULSA-Pro MRI guided prostate ablation in North America post FDA approval of this technology. TULSA- Pro adds another advanced MRI guided treatment option for men with localized prostate cancer.
Prostate cancer can be monitored with active surveillance or can be treated radically by prostatectomy or total gland radiation therapies. These approaches can be appropriate for some patients. However, MRI fusion Guided HIFU or TULSA-Pro ablation of either the entire prostate or only the cancerous portion or the prostate is a non-invasive high-tech approach to treatment that can preserve urinary and erectile function.
The Scionti Prostate Center has developed 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 receives a much higher dosage of focused ultrasound energy than the neighboring areas resulting in more effective ablation and fewer side effects. TULSA-Pro is performed in the MRI suite, under real-time MRI control and offers precise prostate ablation that can be highly personalized like HIFU. Prostate size, configuration, tumor location, and tumor size are factors that determine which treatment( HIFU or TULSA-Pro) is the most appropriate for each patient.
The most commonly accepted prostate cancer treatments in the United States are surgery to remove the prostate and radiation therapy. There have been technological advances in both surgery and radiation over the past 10 years such as Robotic Assisted Surgery, Intensity Modulated Radiation Therapy, Cyberknife Radiosurgery (hypo-fractionated radiation) and Proton Beam Radiation. These advancements have helped to reduce common side effects such as erectile dysfunction and urinary leakage or incontinence. However, even in expert hands, erectile dysfunction may occur in over 50% of patients and urinary leakage requiring pad protection may occur in over 20% of men.
It is being increasingly recognized that prostate cancer is being OVER treated in many men and this has led the U.S. Preventive Services Task Force to give PSA screening a "C" rating, meaning that the overall benefit may be small and that the harms of PSA screening outweigh the survival benefits. PSA screening can lead to a reflex prostate biopsy, and even men with minimal disease were treated traditionally with surgery or radiation—resulting in significant quality of life related side effects.
Today, many men are not offered any alternatives to traditional treatment by their urologists. At the Scionti Prostate Center, we discuss all treatments options and recommend LESS invasive treatment options whenever possible.
Minimally invasive prostate cancer treatment means delivering cancer treatment to the prostate without having to do surgery, without making major incisions. This is called ablation (destruction) which is accomplished by precisely targeting lethal energy to diseased prostate tissue, based on tumor locations revealed by Advanced Diagnostics. The advantages are:
a) quick recovery,
b) no incisions,
c) less collateral damage to neighboring structures
d) better preservation of sexual and urinary function
e) precision individualized treatment
f) leaves all treatment options available if more treatment is needed in the future.
The whole concept of minimally invasive ablative therapy is an exciting frontier in which the Scionti Prostate Center has taken the lead. We have the ability to use advanced MRI fusion to target specific tumor regions in the prostate or to treat the entire gland if that is necessary. Our most effective and precise treatment is MRI Fusion Guided HIFU. Dr. Scionti has pioneered the MRI Mapped Energy Modulated HIFU Technique ( MMM Triple M HIFU)
Dr. Scionti was formerly the Director of Prostate Cancer Ablative Surgery at the Joel E. Smilow Comprehensive Prostate Cancer Center at NYU Langone Medical Center in New York City.
Dr. Scionti has the largest cumulative prostate ablative treatment experience in North America with over 3000 patients treated over the past 20+ years.