BY RALPH BLUM
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.
my own experience of co-existing with prostate for over 20
I remain conservative when it comes to invasive treatment.