Prostate cancer is a big killer in the United States. The latest estimate is that 2014 will see in excess of 233,000 new cases and the disease will claim 29,000 American lives.
These shocking statistics come from the Prostate Cancer Foundation, making the cancer the number one most common non-skin cancer in the US, affecting one in seven men.
Despite the widespread incidence of prostate cancer, screening techniques have seen little advancement for over 30 years. But now a new screening technique offering benefits to the sufferers and physicians alike has come on-stream in the United States, although, for the moment, only the University of Alabama at Birmingham (UAB) Program for Personalized Prostate Cancer Care offers it.
The new method involves the dual processes of magnetic resonance imaging and ultrasound fusion-guided biopsy (MRI-US).
Two assistant professors at UAB’s Department of Urology studied the MRI-US image fusion technique. Doctors Jeffrey Nix and Soroush Rais-Bahram, fellows at the National Cancer Institute, who, together, have five years experience using the new approach, are presently two of only a select few urologist in the US currently trained to use the technology.
They described the technique as offering a “targeted biopsy” meaning that it involves direct tissue sampling of areas suspected of being cancerous as thrown up by an MRI scan in contrast to the established method. The technique that has been in use until now comprises random, systematic sampling. In essence this was done blindly in what the professors term different “ZIP code” regions of the prostate.
Nix described how the pair used prostate MRI scans and fused them with real-time ultrasound for image-guided prostate biopsies. Effectively, this allowed them to zoom in and detect prostate cancer with a high degree of accuracy. It could target lesions of concern as defined by MRI.
“This improves overall detection compared to standard biopsy and, more importantly, has the potential to give clinicians and patients a more accurate picture of their true disease burden by allowing improvements in staging,” said Nix.
But away from the technicalities, Nix went on to outline the many benefits MRI-US had brought about. Not only had it increased overall cancer detection rates but it had also increased the detection rate for high-risk cancers. The method brought the benefit of improving staging for patients diagnosed as suffering from low-risk forms of prostate cancer but whose condition was being closely monitored by their doctor for any changes.
Often biopsies of those suspected of suffering from prostate cancer are inconclusive but where doubts remain that a patient is suffering from the disease despite negative biopsies, the new technique could prove particularly useful.
As Rais-Bahrami put it, “The technique is expected to be especially helpful in cases of men with a history of negative biopsies who are still suspected of having cancer due to a persistently unexplained elevated prostate-specific antigen level, patients with enlarged prostates and patients being guided toward active surveillance for improved staging.”
Prostate-specific antigens, or PSA, are released naturally into a man’s bloodstream by the prostate gland. Healthy men have low amounts of PSA in the blood but the amount of PSA in the blood normally increases as he male prostate enlarges with age. Elevated levels of PSA can be an indication of problems in the prostate. In the US, the Food and Drug Administration has approved the PSA test for annual screening of prostate cancer in men of age 50 and older.
Rais-Bahrami pointed to the example of one of his patients who had a total of five biopsies over the previous seven years. Despite the patient having persistently elevated levels of PSA, each biopsy was negative.
The patient underwent an MRI-US fusion-guided biopsy and Rais-Bahrami and his colleagues were able to target sections they’d identified as areas of concern. One of these areas proved positive for cancer and was probably what had been causing the man’s elevated PSA level during these seven long years.
That instance is important in underlining the possible benefits of early detection. Five biopsies had all missed the problem but using an MRI-US fusion-guided biopsy quickly spotted it.
The new technique is no more invasive for the patient than present-day conventional biopsies. MRI-US is a clinic-based procedure that can be performed under local anesthesia.
MRI-US has been in use at UAB over the past year and Nix reports seeing a lot of success with the MRI-US fusion biopsy finding significantly more extensive disease in several patients who were previously on active surveillance.
As well as MRI-US enabling more informed decisions on appropriate treatment, many prostate cancer sufferers went on to receive treatment that cured the disease.
Nix hailed MRI-US as, “the first major advancement in prostate cancer detection in more than 30 years, and it’s a significant improvement”.
Image: Soroush Rais-Bahrami, far right, and Jeffrey Nix assistant professors at University of Alabama at Birmingham (UAB) department of Urology who’ve studied the new magnetic resonance imaging and ultrasound fusion-guided biopsy (MRI-US) method of screening for prostate cancer. (Credit: University of Alabama at Birmingham)