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I think this might be a hot topic for the group. I have noticed as I have gone through my process of being diagnosed with PCa that nothing has changed in this process since my father was treated. The only small change I have found is that the PSA test has been refined.
There are only three ways for this cancer to be caught at am early stage; PSA, DRE and biopsy. All of these depend on luck. Personally the prostate biopsy sucks as a way of determining if you have the disease. You might as well use a magic 8 ball.
I'm wondering if anyone in this group has heard of other more accurate, less offensive methods of doing this evaluation that would be of interest to future members of this group.
I have heard that there is an international group studying this problem and they are focusing on MRI. As I learn more I will post it to this string.
More accurate possibly; less offensive, probably not. I'm talking about template guided biopsy, otherwise sometimes known as saturation biopsy. This can involve up to 60 cores taken trans-perineally using a grid system. The sheer number of cores, combined with the grid system gives a much greater chance of finding any cancer that may be present and determining its location. Unlike a normal TRUS biopsy, the template guided biopsy is carried out under general anaesthetic. Depending on how you react to a GA, this may be more, or less offensive. Speaking personally, I found the after-effects from a template guided biopsy to be no worse than a TRUS biopsy.
Combining a template guided biopsy with a high resolution MRI scan increases the chances of locating tumours if they are present, although of course smaller tumours may not be picked up. There is a school of thought which suggests that contrary to normal practice, the MRI scan should be carried out before the template guided biopsy. The biopsy can create artefacts which can be confused with tumours if the MRI scan is carried out afterwards.
A biopsy is the only way to identify PC. An MRIS is valuable in identifying areas of suspicion, but unless it is done with a 3 Telsa it is not very accurrate.
The least invasive way is a color doppler ultrasound tarteted biopsy, done by an expert, either Dr Duke Bahn or Dr Fred Lee or dr Doug Chin.
The value of the color doppler is that it can accurrately identify suspicious areas for biopsy and determine the exact location, volume and sometimes agressiveness.
JohnT
John, you are absolutely correct. It seems to me that doing a biopsy with a less than accurate sampling method would not produce the best result. I was skeaking with a colleague today and he directed me to the UCLA Website on MRIS diagnosis of PCa. http://www.radnet.ucla.edu/radweb/sections/abdominal/news/prostateMRI.jsp
I'm curious why this technique is not the first method used to detect cancer rather than just randomly poking at the prostrate. I assume this could be a debate over cost or who gets the money to do the work. At the end of the day it seems as though the patients comfort and care is not taken into consideration during this process.
I think the original question here has been answered. There are other methods, but they don't appear on the menu.
Greg,
My urologist was not randomly poking from what he told me immediately thereafter. He was viewing an ultrasound image and could detect contours and other patterns and densities within the prostate. Several of his samples came back with very high cancer percentages even though my overall prostate was just 10-15% cancer according to the full biopsy after surgery. As I recall he took about 8 or 10 cores, being sure to sample both sides. So the initial biopsy is perhaps another procedure where an experienced doctor will do much better than others.
Bill, my doctor was also not randomly poking because he had been doing this procedure for more than 30 years. There are many fine doctors out there that are using the latest equipment and do a good job at performing the biopsy.
Unfortunately, there are many other docs who don't have that experience because they just finsihed their learning process, which in the medical community is done by the "See one, do one" process. There are too many biopsies that turn up negative when in reality you are positive. All I am saying is there must be a better way to get an accurate diagnosis. I would rather be told all the options for my treatment and be allowed to make an informed decision rather than not.
The other factor in this equation is the patient. Some cancers are very difficult to find and a more comprehensive method needs to be developed to give the patient the best chance to be properly evaluated irregardless of the doctors skill or the patients stage of disease.
This is a common problem in many areas of medicine and needs to be addressed if we are to get the proper treatment in a timely manner.
I was one of those difficult cases undergoing 13 biopsies and over 150 core samples in 10 years. I also had an MRIS which was also negative. I finally had a color doppler that showed a suspicious area and was referred to Dr Bahn who used color doppler to perform targeted biopsies. He discovered a large G 4+3 tumor. The MRIS was not pleasent, having to spend over an hour in a tube with an endorectal coil up your butt. The color doppler was the most accurrate and the least invasive.
JohnT
Thanks for the information. This looks like an interesting detection method. I will talk to my UCLA contatc and see what type may be able to do to help. It is just a matter of putting all the pieces together and I think we can move this process forward,
