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.
