The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, January 6, 2015

Confessions of a Treatment Conservative


While studies demonstrate that the new gold standard for detection of clinically significant prostate cancer with a high degree of certainty is a combination of systematic and MRI targeted biopsies, the practicality of this approach still poses problems.

Mark has written many times about the growing pains involved in the common sense use of this sophisticated technology, and also its tremendous potential to finally help distinguish men with non-aggressive cancer who do not need treatment from those with aggressive disease who do.

Making this technology available to every man with prostate cancer who would benefit from it is problematic for one main reason—the process is not very available due to the relatively few centers of excellence that have access both to the technology, and to the highly skilled uro-radiologists capable of reading the MRI scans with accuracy.

Prostate cancer affects men in many different ways. Its management is complicated by extremely variable behavior patterns ranging from slow-growing and insignificant to rapidly growing and life-threatening. Sometimes an abnormal PSA suggests cancer but none is found at biopsy. Sometimes a man who is thought to be a good candidate for surgery will turn out to have cancer that cannot be effectively treated surgically. Other times a decision has to be made whether to treat what appears to be a very small amount of cancer and risk the inevitable side effects. All of these are issues where prostate MRI is of value.

The biggest challenge in prostate cancer treatment is to try to find all the cancer, but treat only that cancer which is aggressive. Multiparametric MRI scans can help identify areas in the prostate that are suspicious for aggressive cancer that can be missed by biopsy. They also happen to be safer, minimally invasive, and less uncomfortable!

The main reason that Mark and I wrote our book—Invasion of the Prostate Snatchers—was to try to prevent the exorbitant number of biopsies performed every year in the United States leading to immediate radical treatment that in many cases was totally unnecessary.

There is no doubt that advances in MRI technology could dramatically curb the number of biopsies performed and reduce unnecessary treatment of non-life-threatening cancers.  From my own experience of co-existing with prostate for over 20 years cancer, I remain conservative when it comes to invasive treatment.


Dave said...

Is there a list of "Centers of Excelence" where I could go outside of Southern California?

I recently relocated to Reno,NV. Carson City is to the South. Bay area is over the "hill" maybe 3 hours away. Otherwise I'll have to set up a trip to Liberty Pacific .. takes funds and more time .. more of both...

Prostate Oncology Specialists said...

PCRI lists them here - if we have updates, we will post those too.