Introducing Color Doppler Ultrasound

BY RALPH BLUM

Accurate information about the status of your prostate cancer is essential for determining whether you need treatment, or whether you can safely continue with active surveillance. Although some centers of excellence like Memorial Sloan-Kettering and the University of California, San Francisco, use spectrographic MRI, most urology practices still rely on repeated random biopsies as their primary form of monitoring—despite the risks and discomfort involved.

As I have said before, I am no fan of biopsies. As far as I am concerned biopsies are a necessary evil. But under no circumstances should men allow themselves to be rushed into having one before less invasive diagnostic methods have been explored. Having said that, a S-MRI means traveling to a specialized facility, costs a small fortune, and involves having a probe that is called an “endorectal coil” inserted up your butt to improve the image quality.

Fortunately, there is another form of prostate imaging—color Doppler ultrasound—that is considered comparable in quality to S-MRI. It is also easier to perform, takes less time, can be done in the doctor’s office (Prostate Oncology Specialists, Mark Scholz’s office, has color Doppler capability), and requires a much smaller probe than the S-MRI. Big plus! Color Doppler ultrasound provides higher resolution images than the usual gray-scale ultrasound machine, and also “sees” areas of new blood vessel formation (angiogenesis) associated with higher-grade, more aggressive prostate cancers. (I will look more closely at this process in my next Blog.)

Color Doppler ultrasound will, in time, be widely used in clinical practice to evaluate blood flow through organs or tumors. Thanks to its simplicity, ease of use, speed, and safety, ultrasound imaging is being increasingly employed to monitor angiogenesis for diagnosis, treatment assessment, follow-up, and therapy guidance.

All monitoring tools have limitations, including biopsies. Color Doppler is only one of many tools that provide useful information about the status of cancer in the prostate. It was from the color Doppler imaging of Dr. Duke Bahn back in 2008 that I learned the reassuring news of no new blood flow and the stalled growth of my tumor. This accurate feedback, confirming how my cancer was behaving, made it safe for me to continue to watch and wait and avoid radical treatment. A blessing for which I will always be grateful.