PSA and PCA3

Prostate cancer is second, only to lung cancer, as the cause of cancer-related deaths in men. Roughly 250,000 new cases were diagnosed in 2013. Approximately 34,000 men will die annually from this disease.

PSA blood testing has raised the awareness of prostate cancer. It is a very sensitive test that determines activity with the prostate; however a high PSA may be indication of an enlarged, benign prostate. Therefore PSA results do require further testing to in order to diagnose prostate cancer.

New technology is changing the way we think about the treatment of prostate cancer. PCA3 is a urine test that is very specific in its ability to identify prostate cancer. PCA3 is a protein produced in normal prostate cells, however when malignancy is present, the amount of PCA3 in the urine is much higher. This is a FDA approved test and is a welcome noninvasive test.

When is it necessary to do a prostate biopsy?

You’ve may have experienced or at least heard this scenario. Urologist to the patient, “Well it looks like your PSA is elevated, let’s schedule you for a prostate biopsy.” Really, just that quick?

It wasn’t too long ago, biopsy seemed like the only option to tell if a man’s PSA was elevated because of a prostate cancer. After all PSA, although a very good diagnostic blood test, is not cancer specific. In other words PSA elevation may be due to an enlarged prostate, a prostate infection or stimulation to the prostate gland or it could be a malignancy. And come to think of it, what if we do a prostate biopsy and the needle misses the cancer?

We’ve come a long way in the understanding how to diagnose and treat this potentially deadly disease, prostate cancer. Yes, prostate biopsy is important, but let’s takes a step back for a moment. What if we had a biomarker (like PCA3) for the urine, that if it is was elevated then we could take the next step.

What if we could look a prostate by imaging it, just like we do with other glands and organs in the body? By using a high magnet, 3T MRI, which provides us with a road map of the prostate we could see if an area that looks suspicious and then we can take the next step.

If we reduce the number of prostate biopsies, and improve the information that we get when we do biopsy, then we have made progress and yes we have all this technology available to us right now.

Dr. Herb was interviewed by Ken Gordon of the Columbus Dispatch about the rise of vasectomies during March Madness.

Read the full article here.Columbus Dispatch article

Why do Men Get Vasectomies?

The following was from Dr. Turek’s blog. View his blog at http://theturekclinic.com/blog/

Why do Men Get Vasectomies?

I ask most patients why they are considering a vasectomy. The responses vary, but can be very amusing. Here are a dozen of the funniest answers I’ve heard in my practice:

1.    My wife said: “the factory is closed,” so I’m here.

2.    I was told that they broke the mold after they made me, but I want to make sure of it.

3.    My wife said: “It’s your turn now.”

4.    After this, I won’t ever have to say I’m sorry again.

5.    I’m married! Condoms are sooo high school!

6.    Have you seen the movie ‘One Fine Day?’ That’s why I’m here!

7.    Every time I look at my wife, she gets pregnant.

8.    Apparently, sacrificing some limbs just isn’t the same…

9.    She told me: “Enough, get your wings clipped already!”

10.  I was told that I can shoot the gun all I want and no one will get hit.

11.  I heard that it’s easier than getting your teeth pulled out…

12.  My wife told me that it’s time for juice without seeds.

So, here’s to the most effective contraceptive ever developed and hats off to those men who chose the “emission impossible” way to an unburdened and unbridled sex life.

Prostate Cancer the Answers Are Here Focal Therapy HIFU, 3TMRI and PCA3

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.