Better Prostate Cancer Detection

BACKGROUND: According to the American Cancer Society, more than 232,000 men in the United States will be diagnosed with prostate cancer this year. More than 30,300 men will die from the disease. While one man in six will get prostate cancer during his lifetime, only one man in 34 will die from it. If a man is suspected of having prostate cancer with an abnormal PSA test or by a digital rectal exam, doctors will then do a transrectal ultrasound-guided biopsy (TRUS). A TRUS biopsy - which is the current standard - removes a few samples of the prostate to determine whether cancer is present.

CAN YOU TRUST THE TRUS?
Gary Onik, M.D., the Director of Florida Hospital/Celebration Health's Prostate Cancer Research Program, says, "Unfortunately, we're finding that [the TRUS biopsy] is really not very effective at all. When you look at the statistics of a normal size gland ... the chances of actually finding that tumor are about 15 percent. So, 85 percent of patients by that biopsy method may be missing their cancer." You might be asking -- how can this possibly be the gold standard? Dr. Onik says, "Because we didn’t have any other way of knowing that we were doing it incorrectly." Now, there is a new, much more reliable way to get an accurate diagnosis.

3D MAPPING
A new biopsy method, called 3D mapping, uses a grid placed over the prostate to determine exactly how much cancer there is and exactly where it is in the prostate. Dr. Onik explains, "It's like playing Battleship with the prostate. Every hole that we have has a coordinate, and we can place the needle through that. We have a picture that overlays and shows us the prostate and where that biopsy's being taken from. Then, we can basically look at the picture when we get a positive biopsy back and see exactly where the cancer is in the gland.” In a TRUS biopsy, the samples are taken through the rectum, so doctors can only get about 12 samples. With the new 3D mapping method, biopsies are taken through the skin so doctors are able to get many more -- even up to 100 -- samples. By getting so many more samples, doctors can determine how widespread the cancer is. If only one or two samples out of 100 come back with a slight percentage of cancer, it could be a much different prognosis and treatment regimen than if half of the samples came back showing significant cancer.

BENEFITS FOR PATIENTS
Dr. Onik says, "A lot of patients are being treated inappropriately with the wrong therapies because they’re either under-diagnosed or over-diagnosed." He says many men who choose watchful waiting as a therapy may be doing so with a very inaccurate diagnosis. He says, "When we biopsy them [with 3D mapping], we find that a lot of them have very significant cancer that needs to be treated but wouldn’t have been treated unless we had done this biopsy." On the other hand, Dr. Onik says some men may get an inaccurate or incomplete diagnosis with a TRUS biopsy and decide to have a radical prostatectomy. He says, "Sometimes, we see patients who are ready to have their prostate gland and everything removed, and we do this [3D mapping] biopsy, and we can’t even find their tumor."

WHERE IS IT?
Currently, Dr. Onik says there are about five centers in Florida doing the 3D mapping biopsy method. More studies are planned, and Dr. Onik expects that this method will become widespread across the country within a few years. He adds, "This is one of those times where I think this will possibly change the way we look at prostate cancer."

FOR MORE INFORMATION
http://www.hopeforprostatecancer.com/