There are rapid changes that are related to the diagnosis and treatment of prostate cancer. In the United States in 2011 there were 241,000 new cases diagnosed and 34,000 deaths, this is second only to the death rate of lung cancer. Tumor markers or blood tests that are used to diagnose this disease at times create significant controversy. The most in the news is PSA. This test is very sensitive but it's not specific. However there is a new FDA approved marker PCA 3 which is much more specific. If we combine these two there is a good opportunity of identifying significant prostate cancers. In other words the two used together give us meaningful information about who should have additional testing.
We gain information about prostate cancer that we can find by doing a mapping biopsy. What we learn in these cases is that patients can have more than one grade of cancer within the prostate, some very low-grade and called insignificant cancer. Some cancers are much higher grade and these can lead to wide spread disease. This aggressive cancer usually is larger than insignificant cancer and can be identified. Early diagnosis means identifying the cancer before it spreads and makes it possible to destroy it within the prostate
High quality imaging of prostate today means an MRI image when done with a high-powered magnet known as 3 Tesla, this image can demonstrate the anatomy of the prostate we can see within the prostate. 3T MRI has a very good opportunity of identifying aggressive cancer within the prostate where it can be cured. This then leads to the concept of early diagnosis of aggressive cancer. With this information we now have the opportunity to focus our attention and develop a target of the bad prostate tissue. This is done precisely and the MRI images done previously can be coordinated with a new treatment technique and we can achieve cure by only treating the targeted aggressive tumor cells within the prostate.
High intensity focused ultrasound (HIFU) is one of the treatment tools that is rapidly developing to give us to have focal therapy of prostate cancer, much like focal treatment of breast cancer, known as lumpectomy.
Although HIFU is not currently approved within the United States, it will be in the near future. It is currently being used in clinical trials in the US and is currently available outside the US. Our goal is early detection of significant prostate cancer. We can do this with PCA 3, PSA and very sophisticated imaging. The objective is for the urologists to characterize the individual patient with this diagnosis and tailor an approach for that individual patient. In cases these can treat specific areas that represent the bad tissue (malignancy) within the prostate using HIFU
HIFU utilizes an ultrasound probe... In this case however the probe produces ultrasound energy and then focuses it so that it can pass through adjacent tissue without creating harm and produce a very small but precisely focused amount of energy at the target. Almost everyone can remember in childhood when we used a magnifying glass and focused the sun's rays so we could set a piece of paper on fire or possibly etch our name in a piece of wood. You'll also remember that unless you were at the point where the sun's rays had converged into a small pinpoint you could pass your hand through the rays and it would not even be warm.
This is the same principle; the ultrasound probe uses to provide the energy that is used in HIFU. The energy however is ultrasound. This therapy is controlled in the same as the sun is with the magnifying glass. It then enters the prostate then converges to produce high heat at the target. Using this with computer guidance allows us to target the bad tissues and destroy it. This leaves the majority of the prostate untouched. We combine this level of selective application of energy with the marvelous images that we're getting from the 3Tesla MRI and we can now produce focal therapy that has the potential to cure prostate cancer without treating the whole organ. In other words the prostate no longer will have to be totally radiated or totality frozen or removed.
In February 2013 Riverside Urology held an Educational Seminar in Columbus, Ohio with multiple expert lecturers discussing these topics. That presentation was recorded, condensed and posted to YouTube. Please take a moment to view the video, HIFU909 http://youtu.be/r4sf9YX7cYg Thank you.