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Technology on Target

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A state-of-the-art prostate cancer diagnostic procedure is saving lives.

DrDonaldBellProstate cancer is the second most common cause of death among American men, following skin cancer. In 2013, it claimed nearly 28,000 lives. However, a groundbreaking technology is helping doctors change that statistic for the better.

To diagnose patients with prostate cancer, doctors first identify elevated levels of prostate-specific antigen (PSA), as higher levels of this enzyme can indicate prostate cancer or other prostate disorders. The next step is usually biopsy. “Traditionally, prostate cancer has been diagnosed using what we call ‘blind’ or ‘quadrant’ biopsy,” says Dr. Donald Bell, a urologist at East Jefferson General Hospital.

“Anyone who had an elevated PSA or palpable abnormality would undergo a transrectal ultrasound and biopsy.”

Because ultrasound technology is unable to accurately identify prostate cancer, multiple biopsies typically accompany the transrectal ultrasound procedure. “What that did was find a number of patients who had prostate cancer — that was unlikely to ever cause them harm — but it also missed many individuals who had significant cancers that were outside that typical template,” Dr. Bell says.

In recent years, a technology known as multiparametric magnetic resonance imaging (MRI) has allowed doctors to more accurately target areas of the prostate that may be at risk of harboring cancer. “The exciting new technology is a fusion of transrectal ultrasound with MRI imaging,” Dr. Bell explains. “In utilizing multiparametric MRI, we can identify areas of the prostate that have a high likelihood or a low likelihood of prostate cancer. When we identify those high-risk areas … we can use ultrasound fusion technology to allow the urologist to biopsy that area.”

Not only does the fusion of multiparametric MRI and ultrasound offer more precise targeting of high-cancer-risk areas, it also cuts down on the number of biopsies a patient will have to undergo. “The ability to return to the previous biopsy site is highly accurate,” Dr. Bell says. “Our targeted biopsies are two to three times more sensitive than non-targeted [traditional] biopsies.”

Patients with a low risk of developing prostate cancer follow what’s called an “active surveillance” protocol, during which their physician performs regularly scheduled PSA-level checks and rectal exams, as well as periodic re-biopsies.

Higher-risk patients whose biopsies confirm the presence of malignant cancer cells have several treatment options available. “If, in fact, the biopsy confirms prostate cancer that is likely to cause harm to the patient, then there are multiple types of treatments offered,” Dr. Bell says. “Those treatments generally fall into two categories: either radiation therapy or surgical therapy.”

Dr. Bell is often asked what the multiparametric MRI procedure involves. “Currently, the technology is that it’s a relatively enclosed machine,” he says. “There is some claustrophobia, and it’s noisy — but other than that, it’s not painful.” Apart from a simple intravenous line through which the MRI contrast for the procedure will be administered, no insertion of a catheter or any other instrument is needed to perform the multiparametric MRI.

Current systematic biopsies will fail to diagnose prostate cancer almost 35 percent of the time, according to Dr. Bell — so the advent of the multiparametric MRI procedure is a huge step forward. “We believe this is really going to change prostate cancer diagnosis and treatment,” he says.