For doctors, finding prostate cancer during a biopsy is akin to finding a needle in a haystack while blindfolded.
Leonard Marks, MD, University of California-Los Angeles (UCLA) professor of urology and director of the UCLA Active Surveillance Program says “amazingly, prostate cancer is being diagnosed today almost exactly same way it was 25 years ago” using a technique known as the “blind biopsy”.
Prostate cancer is the only major malignancy diagnosed without actually visualizing the tumor during a biopsy. That’s because doctors can’t actually see the tumor during the procedure. They work blind as ultrasound guides the needle to different parts of the prostate to gather tissue samples.
Dr. Marks said that, as a result, 75 percent of the nearly one million biopsies for prostate cancer performed each year are negative for cancer. However, many men with negative biopsies but elevated serum PSA levels may still harbor malignant tumors that were missed by conventional biopsies.
But now, a UCLA team of physicians and engineers have demonstrated in a groundbreaking study that prostate cancer can be more accurately diagnosed using a cool new tool called Artemis, which makes image-guided targeted biopsy possible.
The researchers used Magnetic Resonance Imaging (MRI) along with real time ultrasound to solve an age-old problem: how to give doctors a way to see what they are aiming for.
The new technology not only allows doctors to visually inspect a prostate for cancer during the biopsy, they can now do it 3-D high-resolution images in a much more refined manner.
This means more men with serious prostate cancers may be diagnosed earlier. And for those who have less serious cancers, they can avoid unnecessary procedures — along with the accompanying risks and side effects.
Robert Meier, a 58-year-old high school art teacher from Visalia, Calif. was one of 171 men who enrolled in Dr. Mark’s study in 2011, after three prior prostate biopsies all came back negative for cancer despite his climbing PSA levels.
An MRI revealed a prostate lesion and he underwent a biopsy using the Artemis device. He did have cancer, and it was aggressive.
Meier’s prostate and 24 nearby lymph nodes were removed robotically in Feb. 2012 by Dr. Arnold Chin, UCLA assistant professor of urology. Follow up tests show that Meier is cancer-free today.
“I had jumped through all these hoops and had all these tests with two different doctors and they found nothing. These [traditional] biopsies can be extremely painful and I was put in the hospital several times so they could be done under general anesthesia,” Meier said in a statement. “It takes about a month to recover.”
Today Meier is grateful for the new technology and his doctors at UCLA. “It took UCLA to determine that I had an aggressive cancer that could have killed me. This program works,” he said.
Dr. Daniel Margolis, a radiologist at UCLA and one of the study’s researchers, says prostate cancer has become so prevalent its likely most men will be diagnosed with prostate cancer during their lifetime.
Approximately 240,000 prostate cancers will be diagnosed in the United States this year, but not every prostate cancer is deadly.
“Unlike a lot of other cancers, including breast, lung and colon, there are some prostate cancers that can just sit there [without worsening] but they don’t kill you. So even though they are technically cancer, they are a non-lethal cancer," Dr. Margolis said.
When cancer is found, often it’s difficult for doctors to gauge which prostate cancers are lethal and which are non-lethal. So as a precaution, it has been standard procedure to do surgery, which could potentially be unnecessary, said Dr. Jiaoti Huang, a medical pathologist at UCLA Medical Center who is associated with the study. “Our goal is to change that,” he added.
There is growing evidence that many of these non-lethal prostate cancer patients don’t require standard medical treatments to live, but they do require careful monitoring. The key is improving diagnosis and surveillance by improving the cancer biopsy, the only way to currently diagnose prostate cancer.
The UCLA study found MRI and 3-D ultrasound fusion biopsy is much more accurate than conventional blind biopsy and that it may lead to a reduction in the numbers of prostate biopsies performed.
Until now, using MRI to see potential prostate tumors or lesions was impractical. The technology has evolved to where targeted biopsies can be done in a clinical setting, Dr. Marks said.
“Artemis has delivered very dramatic results, and the rate of cancer detection in these targeted biopsies is very high. We’re finding a lot of tumors that hadn’t been found before using conventional biopsies.”
The study is published early online for The Journal of Urology January 2013 issue and was funded by the National Cancer Institute.
Lynette Summerill is an award-winning writer and Scuba enthusiast who lives in San Diego with her husband and two beach loving dogs. Besides writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.
Sources:
Prostate Cancer Detectable by Targeted Biopsy, Ending Era of Blind Biopsies. UCLA. Kim Irwin. Video at:
http://www.youtube.com/watch?v=IcLwL2dcK5o
Targeted Biospy in the Dectection of Prostate Cancer Using an Office Based Magnetic Resonance Ultrasound Fusion Device. Geoffrey A. Sonn, Shyam Natarajan, Daniel J.A. Margolis, Malu MacAiran, Patricia Lieu, Jiaoti Huang, Frederick J. Dorey, Leonard S. Marks. Published early online 15 Nov. 2012; The Journal of Urology, January 2013. Vol. 189, Issue 1, Pages 86-92, DOI: 10.1016/j.juro.2012.08.095. Abstract at:
http://www.jurology.com/article/S0022-5347%2812%2904714-3/abstract
What You Need to Know About Prostate Cancer. National Cancer Institute. Access online at:
http://www.cancer.gov/cancertopics/types/prostate
Prostate cancer now detectable using imaging-guided biopsy, UCLA study shows by Kim Irwin. UCLA Newsroom. Retrieved Dec. 23, 2012.
http://newsroom.ucla.edu/portal/ucla/prostate-cancer-now-detectable-241575.aspx
Reviewed December 23, 2012
by Michele Blacksberg RN
Edited by Jody Smith