Diagnosis and treatment of prostate cancer (PCa) has undergone a sea change. Used to be, urologists did a painful, uncomfortable ultrasound-guided needle biopsy to look for cancer. But today, although that procedure is still used for initial diagnoses, the development of a staging prostate biopsy is replacing the former gold standard, according to a story by medimaging.net writers.
Called the transperineal three-dimensional (3D) mapping biopsy, or PSB, this procedure helps “physicians understand better the stage and gravity of the cancer in order to make more informed treatment decisions,” according to the story.
About 240,890 new cases of prostate cancer will be diagnosed this year and approximately 33,720 men will die of the disease, according to cancer.org.
“We have been working hard to bring prostate cancer diagnosis and treatment to more advanced states. Our approach follows similar efforts from breast cancer patients and advocates, which have led to the decline of radical mastectomies, an increase in research and better diagnostic test, treatment, and surgical options,” Dr. E. David Crawford, chairman, Prostate Conditions Education Council (Centennial, CO, USA) and professor of urology and radiation oncology, University of Colorado (Boulder, USA), told medimaging.net writers. The hope is that prostate staging biopsies will give physicians a clearer picture and better understanding of how aggressive and far along the disease is in patients, allowing them to develop more customized treatment plans, according to the story.
“We expect to see a decline in the number of men who are undergoing unnecessary prostatectomies or radiotherapy,” said Dr. Crawford in the story. “This, coupled with new focalized treatments that are the equivalent of the ‘male lumpectomy,’ should help us see an increase in positive outcomes for men diagnosed with the disease.”
Almost all men experience bruising around the perineum and have temporary blood in the urine and painful or difficult urination following a PSB, according to medterms.com. And in some, urinary retention occurs in between five to 10 per cent of patients as well, according to the Web site.The needle biopsy is done on an outpatient basis and is a surgical procedure in which a transrectal ultrasound produces an image of the prostate, allowing a physician to guide a small needle to take 6-12 samples of prostate tissue to test for abnormal cells and tissue, according to the story.
For many years, it was the gold standard for diagnosing prostate cancer. But it’s not good at finding gray areas and “under- and over-grading of the cancer” happens frequently, causing patients to often undergo unnecessarily invasive treatments invasive or running the risk of dying from other treatment methods, the story notes.
The prostate staging biopsy (PSB) is performed as an outpatient procedure but under general anesthesia, according to medimaging.net writers. Unlike ultrasound, it allows physicians to create a 3D image of the prostate, “including the location of the cancer within the organ,” the story says. Because PSB gives a much clearer, more detailed view of the size and location of the cancer, it makes it easier for patients and their physicians to choose a more appropriate treatment option, including “watching and waiting.”
In a recent study, according to the medimaging.net story, 215 men had PSBs. Only 38 chose to have radical prostatectomy, while the majority of the remaining men chose targeted therapy and 44,”watchful waiting.” Reassuringly, no studies have found a significant difference in the risks or complications between the two procedures, as the story reports.
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Deborah DiSesa Hirsch is an award-winning health and technology writer who has worked for newspapers, magazines and IBM in her 20-year career. To read more of her articles, please visit her columnist page.Edited by
Jennifer Russell
