New Prostate Cancer Technology Saving Lives
JM, a 71 year old business executive from Tennessee, had a negative biopsy using gray scale ultrasound despite a PSA of 7.1. The following year, the PSA rose to 11.5 prompting a second biopsy that was negative despite adding Color Flow Doppler Ultrasound. At this point, the patient and all doctors in attendance were frustrated without a clear path to identify a disease process that was begging to be discovered. JM came to the Diagnostic Center for Disease in Sarasota, Florida, as he had heard about an exciting new scan offered that promised to solve his personal dilemma while erasing his fear of the unknown.
Presently, a new case of Prostate cancer is diagnosed every 3 minutes while 90 men die from prostate cancer every day. Prostate Biopsy, the "gold standard" for finding cancer of the prostate is associated with trauma, infection, bleeding and sampling bias. National statistics show that 10 men must undergo an ultrasound and biopsy to find 2-3 cancers. Translated another way, 7-8 men must undergo a procedure that is unnecessary as documented by a negative biopsy. Moreover, it is well known that a biopsy of the prostate is associated with the possibility that cancer cells, if encountered, may be carried outside of the prostate capsule through a phenomenon called, "needle tracking". Data from Pathologists show that this phenomenon is real. The problem is compounded when it is realized that prostate cancer is not just a disease of older men as originally thought but rather a disease of young men as well. In fact, data from the Detroit Autopsy Study and Memorial Sloan- Kettering shows 30% of 30 year old men have prostate cancer.
Given the inability to diagnose prostate cancer using the traditional system, our attention has turned to imaging to determine the presence or absence of prostate cancer. Currently data, primarily from Europe, suggests that prostate cancer detection with MRI-Spectroscopy (MRI-S) has a sensitivity and specificity in the range of 89-92%. In fact, Peter Scardino, M.D., Chairman of the Departments of Urology and Surgery at Memorial Sloan-Kettering has called MRI-S with the 3.0 Tesla magnet, "the next greatest diagnostic tool for prostate cancer detection". The Diagnostic Center for Disease, led by Urologist, Ronald E. Wheeler, M.D., is using this new imaging technology to assist in finding prostate cancer in patients like JM where traditional biopsies continue to miss the lesion. MRI-S evaluates the integrity of prostate tissue through spatial resolution as well as the biochemical makeup of cells through a spectral analysis. Together, this technology establishes a "finger-print" of disease when the PSA is elevated. Once a lesion is identified, a series of targeted biopsies can be performed, as we localize the disease in question.
Using a parametric approach, the center is utilizing all sequences of the 3.0 T MRI-S scan including Dynamic Contrast Enhancement with traditional prostate cancer diagnostic detection markers such as Color Flow Doppler Ultrasound, PSA & DRE to establish a clear picture of the disease process present. Interestingly, this technology often times allows physicians to alter their treatment course when cancer has escaped the prostate capsule. Furthermore, preliminary data from the Diagnostic Center for Disease shows that the use of MRI-S coupled with DRE, PSA and Ultrasound data provides a 75% yield in diagnosing prostate cancer compared to the traditional 20-30% yield while using blind or random biopsies. Dr. Wheeler's mission is to provide a comprehensive approach to Prostate Disease detection that while reproducible, is more patient friendly, allowing Urologists to improve their diagnostic skills, thereby improving their patient treatment outcomes.
While using the MRI-S scan as a "road map", JM needed only 5 targeted biopsies to find the elusive cancer while preventing "needle tracking". Subsequent pathology showed a Gleason Score of 7 (3+4). According to Dr. Wheeler, "while many options of treatment remain for JM, he can at least sleep better knowing the hidden disease that was chasing him had been found".