Posted: Friday, August 26, 2016 – 4:30 PM
By Dr. Kia Michel
One man in six in the U.S. has a chance of developing prostate cancer. While prostate cancer is curable if detected in the early stages, prostate cancer screening and treatment options have had some shortcomings to date. However, recent technological advances are changing the playing field both for men undergoing prostate cancer screening and for those being treated.
Traditionally, men over 50 have been encouraged to undergo prostate screening with a simple blood test (PSA test) and a prostate exam. However, men in their 40s are more commonly being diagnosed, prompting us to recommend they also get screened. In the past, prostate screening has been inexact, as no reliable prostate imaging was available. This has changed. New prostate MRI imaging has proven to be an essential tool. Prostate multi-parametric MRIs use special sequences to detect cancers with high accuracy. This ability to see the cancers is changing how men at risk for prostate cancer are being evaluated, and how men with prostate cancer are being treated.
Traditionally men with elevated PSA levels or abnormal prostate exams have undergone ultrasound guided prostate biopsies to determine if any cancer is present. However, most prostate cancers are not visible on ultrasound evaluations. Therefore, most ultrasound prostate biopsies are essentially blind, random biopsies of the prostate gland, and therefore relatively inexact. With new prostate MRI technology, men are better assessed to determine if they need a biopsy in the first place. For those men who are noted to have suspicious lesions on prostate MRIs, the MRI can clearly show the location and extent of such suspicious lesions, allowing the prostate cancer specialist to have specific targets to biopsy at the time of the evaluation. This special prostate biopsy is referred to as an “MRI Fusion Prostate Biopsy”. MRI fusion biopsies are much more exact than standard ultrasound guided biopsies.
Being able to see the cancers provides a distinct other advantage: it allows prostate cancer specialists to perform focal therapy (a “prostate lumpectomy”). Decades ago, if a woman was diagnosed with breast cancer, the entire breast tissue was removed to ensure that the cancer was eradicated. With better imaging and localization of breast cancers, most women no longer need to have their entire breast removed. Instead, they just have the cancerous area removed, called a “breast lumpectomy” and the otherwise healthy, breast tissue is preserved. To date, the lack of ability to identify the exact location and extent of the prostate cancer has led prostate cancer specialists to recommend the removal of the entire prostate with surgery, or radiation of the entire prostate to ensure that the prostate cancer is adequately treated.
Issues with over-treating the entire prostate are the potential side-effects associated with prostate surgery or prostate radiation, namely erectile dysfunction and loss of urinary control. This over-treatment of the prostate has been in part because of the lack of proper imaging and identification of the location of the prostate cancer cells, and in part because an effective and safe modality to treat only the cancerous areas while preserving the normal, healthy prostate tissue has been missing. Both of these voids have now been filled.
As described, MRI fusion biopsies can effectively localize the location and extent of prostate cancers in men. Now that we can see where the cancer is located, how can we precisely treat it? The answer for many men is HIFU (High Intensity Focused Ultrasound). HIFU is an exciting new treatment approach revolutionizing the treatment of men with prostate cancer. HIFU is a non-surgical treatment modality that uses harmless ultrasound waves with pinpoint accuracy to destroy cancerous tissue.
Given its precision, the normal prostatic tissue and the vital structures around the prostate (such as the nerves that control erections and the muscles that provide urinary control) can be preserved. HIFU is an outpatient procedure. It takes about 1-3 hours to perform and typically has no down time. Given its accuracy, in experienced hands, HIFU can preserve normal erectile function and urinary control while effectively eradicating the prostate cancer.
While advances have been made in optimizing screening and treatment options for prostate cancer, we strongly encourage men to look into prostate cancer prevention. These include dietary modifications and lifestyle changes that can lower a man’s risk of developing prostate cancer in the first place.
Dr. Kia Michel is founding member of the Comprehensive Urology Medical Group and the founder of the Prostate Cancer Specialists of Los Angeles.