Before treating a patient with prostate cancer, it is essential that we accurately detect and diagnose the location of the cancer. The Comprehensive Urology of LA use state-of-the-art technologies to precisely diagnose and target a patient’s cancer.
If you would like to learn more about diagnosis and treatment, please do not hesitate to contact our Los Angeles facility today.
Imaging in Prostate Carcinoma
In the past, imaging capabilities for the prostate have been quite limited. Historically, ultrasounds, CT scans and traditional MRI techniques have been used to try to visualize the prostate and any possible lesions within it. However, these modalities have proven to be quite unsuccessful, as the majority of prostate cancers have been missed using these techniques. Thanks to progress in medical imaging, identifying cancers in the prostate is now possible. By using a new MRI technique, called perfusion dynamic MRI of the prostate, prostate cancer can now be identified with great accuracy. Identifying the location and extent of any cancer allows for more accurate biopsies, and more tailored treatment options including focal therapy, prostate preserving treatments and more exact nerve preservation at the time of whole gland therapies.
Benefits of Prostate Imaging
Thanks to prostate perfusion dynamic MRI, the identification of prostate cancer is better than ever before. This is important in multiple respects.
By being able to see the cancer on the MRI and being able to use the images at the time of a prostate needle biopsy (MRI fusion biopsy), we are now able to diagnose patients with much greater accuracy. This means that erroneous diagnoses at the time of biopsy, such as under-staging a prostate cancer (not hitting the center of the cancer), or missing a cancer altogether, are now much less likely as the MRI technology allows much more accurate identification and localization.
Fewer Biopsies Needed
By being able to evaluate the prostate with much greater accuracy, the need for repeat prostate biopsies is diminished. This leads to less unnecessary biopsies for men.
By being able to identify the size and location of prostate cancers with great precision, we are able to more accurately recommend the right treatment options. This is particularly useful in avoiding misdiagnosis of treatment. For example, many men with small volumes of non-aggressive cancer are recommended to pursue active surveillance. Active surveillance means that a patient’s prostate cancer is not treated initially, but rather it is observed over time (for one to two years, before another biopsy is performed to assess the degree of growth of the cancer), as the risk of progression is considered quite low.
Active surveillance is based on prostate biopsy findings that are suggestive that the prostate cancer is both non-aggressive and very small in size. However, without the use of correct prostate imaging and biopsy techniques, these assumptions can be erroneous. Potentially, a significant cancer can be missed by not accurately biopsying the correct lesion. In turn, by not having the correct information as to the status and size of the cancer, incorrect recommendations for treatment can be made.
Without the proper imaging and biopsy technique, a man with a significant volume of aggressive cancer can be misdiagnosed as having a small, non-threatening tumor. By recommending active surveillance for such a man, the aggressive and life-threatening tumor will not be treated in time (because it is simply being followed without therapy for one to two years), and the man who could otherwise be treated and cured of his cancer gets a significant delay in treatment. In that time, the prostate cancer can grow and spread outside of his prostate to the point which it can no longer be cured.
In some men, recommendations are made for surgery. However, not knowing exactly where the cancer is located can lead to errors during surgery. For example, not knowing if the cancer has grown into the nerves outside the prostate (the nerves that control erections), a surgeon may, with the best of intentions, cut out those nerves (when he didn’t have to) in the hopes that he is removing all of the cancer. By knowing where the cancer is located, a surgeon can remove the tissue with more precision while sparing key vital structures (such as the nerves that control erections) and preserving the muscle groups that control the urinary function.
In other men, radiation therapy of the prostate is recommended based on their clinical status and the type of cancer that is detected. By being able to identify where cancers are located with more precision, the radiation oncologist is able to provide more target-specific radiation therapy, thereby treating the correct segments of the prostate with much higher accuracy, and not radiating (over-treating) otherwise healthy tissue.
Prostate Imaging and Focal Therapy
Perhaps the most exciting advent of MRI imaging of the prostate is that we can now deliver more focal therapies. Focal prostate cancer therapy is a new emerging concept that is available mainly because of the ability to precisely identify the location of the cancer.
Up until recently, if a man was diagnosed with prostate cancer, his entire prostate gland would either be removed surgically or treated with radiation therapy to try to eradicate the cancer altogether. The reasoning behind this is that the entire prostate would be treated if doctors could not accurately determine the extent and location of the cancer in a man’s prostate.
Thanks to more advanced imaging capabilities, however, we can precisely identify the true extent and location of a cancer and therefore selectively treat the cancer and the immediate surrounding area. This prevents us from needlessly treating the rest of the otherwise normal, healthy prostate gland.
Focal therapy is a major advancement in treating patients with prostate carcinoma. By being able to preserve the normal prostate tissue, surgeons are able to improve the quality of life for men by being able to better preserve their normal functions, such as erections, urinary control and bowel functions. Focal therapy of the prostate is mainly performed using HIFU, given its precision to deliver targeted therapy.
Perfusion Dynamic MRI of the Prostate
Perfusion dynamic MRI of the prostate is a new way of evaluating patients with prostate cancer. This is based on the following three principles:
1. Prostate cancers can look different than normal prostate tissue and can therefore be readily identifiable on an MRI of the prostate.
2. Since the blood vessels of prostate cancers can be more “leaky,” cancerous cells excrete contrast material differently than normal prostate cells. During a perfusion dynamic MRI of the prostate, a special contrast agent is used that is picked up and excreted differently by prostate cancer cells as compared to normal prostate tissue. This difference in contrast absorption and excretion can help identify the location of the cancer with great precision.
3. Since the cells in most prostate cancers are more tightly packed than the cells in the normal prostate tissue, water does not travel through the cancerous tissue as easily as it does through the normal prostatic tissue. A perfusion dynamic MRI study is able to identify the difference in the flow of water in the more tightly packed cancer as compared to the less compact normal prostate tissue. By being able to identify this difference in water flow, we can, with great precision, identify the location and extent of the cancerous cells.
The precision of perfusion dynamic MRI allows us to:
- Precisely identify patients at risk of prostate cancer, and therefore help identify who does and doesn’t need to have a prostate biopsy (this cuts down on unnecessary biopsies being performed).
- Perform prostate biopsies with more precision (MRI fusion biopsies).
- Precisely identify the grade and size of the tumor.
- Determine the best treatment option for patients with prostate cancer. (Active surveillance vs. focal therapy vs. whole gland therapy such as robotic surgery and radiation therapy. In addition, our doctors will determine the best course of action regarding alternative therapeutic options and systemic therapy).
- Provide a better road map for our robotic surgeons and radiation therapists when they operate or provide radiation therapy.
- Optimize patient’s outcomes by aiming to preserve their normal bodily functions while providing them with the best cancer cure options possible.
Contact Los Angeles Urology Experts Today!
Comprehensive Urology consists of experts in diagnosing prostate cancer. If you would like to schedule a consultation at our advanced facilities, please call (310) 341-2557 or book online.