Prostate Cancer

The prostate is a small gland that sits underneath the urinary bladder, and surrounds the urethra, the channel through which you urinate. The prostate is about the size of a walnut, and usually begins to enlarge after age forty.  The function of the prostate is to make semen, the fluid that the sperm swim in.

Prostate cancer

Prostate cancer is the abnormal growth of prostate cells, whereby the cells grow out of control. Prostate cancer comes is various types, from a very slow growing type to a very fast growing type.

Prostate cancer can be classified according to the Gleason score, a scale based on the cancer’s microscopic appearance, following a prostate biopsy. Usually, the biopsy is the result of any man having an elevated PSA (prostate specific antigen) blood test or an abnormal digital rectal examination.

After biopsying the prostate under ultrasound guidance, a pathologist grades the most common tumor pattern, and also assigns a second grade to the next most common tumor pattern. The two grades are added together to get a Gleason score. For example, if the most common tumor pattern was grade 3, and the next most common tumor pattern was grade 4, the Gleason score would be 3+4 = 7.

The Gleason score is also known as the Gleason sum and ranges from 2 to 10, with 10 having the worst prognosis. It’s important to understand that for Gleason score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4. Also, there is not really any difference between the aggressiveness of a Gleason score 9 or 10 tumor.

Once the grade is known, the urologist establishes its stage, which is a determination of its extent:

• Stage T1: Normal digital exam, but elevated PSA
• Stage T2: Palpable prostate nodule, but limited to the prostate
• Stage T3: Nodule extending beyond the borders of the prostate
• Stage T4: Cancer spread to other organs

In the modern era, over 90 percent of prostate cancers are detected at potentially curable stages (T1, T2, and some T3’s).  For low-grade cancers (Gleason score 6 or less), low-stage cancers (T1 and T2), and low PSA levels (less than 10), often no additional testing is necessary.

For higher grade, higher stage, or higher PSA cancers, usually tests are ordered to determine if the cancer is still confined to the prostate, or if it has spread to other regions of the body.  Common tests are a bone scan, chest X-ray, CT scan of the abdomen and pelvis, and MRI.  Your urologist will advise you if any of these tests are necessary.

Treatment of prostate cancer

Once the grade and stage are known, your urologist will discuss all the treatment options.

Low-stage cancers (T1 and T2) are good candidates for radical prostatectomy, or total removal of the prostate, for healthy men, with a long life expectancy (more than ten years).

Some men are not healthy enough for surgery or prefer alternate treatment options, such as active surveillance (watchful waiting), external-beam radiation therapy, interstitial brachytherapy (seeds) or hormone therapy (androgen-deprivation therapy).  There are advantages and disadvantages with each of these approaches, and your urologist can discuss each appropriate treatment option based on age, general health, life expectancy, and your particular needs.

Targeted MRI/Ultrasound Fusion Biopsy

A more accurate prostate cancer testing technology is targeted MRI/Ultrasound fusion biopsy. MRI technology combined with the standard ultrasound imaging from the trans-rectal ultrasound prostate exam to create a 3D roadmap of the patient’s prostate exposing areas that were previously not visible during traditional ultrasound screening. This thorough diagnostic technology has led to the discovery of early stage tumors improving the patient’s prognosis and treatment options.

The technology combines two systems, the DynaCAD for Prostate and the UroNav fusion biopsy system. This advanced technology fuses pre-biopsy MR images of the prostate with ultrasound guided biopsy images in real time, for excellent visualization and targeting of the possible prostate cancer. It is poised to become the new standard in prostate care.

Benefits

• A normal Prostate MRI is 90 percent accurate for excluding the presence of prostate cancer. A normal MRI may eliminate the need for a prostate biopsy, avoiding the discomfort and small risk associated with a biopsy.
• Prostate MRI can potentially identify specific areas within the gland that are suspicious and require further evaluation.
• Performing biopsy with MRI/ultrasound fusion guided is more accurate in targeting the suspicious areas, which may have been “hiding” in the prostate.
• Finding cancer early means treatment begins earlier and outcomes are better.

Who is a candidate?

• Patients with elevated Prostate-Specific Antigen (PSA) level 4 or greater.
• Patients with prior negative trans-rectal ultrasound guided biopsy with continued elevation or rising PSA.
• Patients with positive digital rectal examination with negative trans-rectal ultrasound guided biopsy.