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Diagnosing prostate cancer: Beyond the PSA

June 24, 2015 | Patricia Harriman

Dr. Edward Uchio working with the Artemis targeted biopsy system.

Your doctor says the results of your PSA test indicate the possibility of prostate cancer.

Unfortunately, PSA is not a very good measurement of cancer and a suspicious score may indicate inflammation, infection or age-related prostate enlargement. Although it is the second-most common cancer diagnosis for American men, prostate cancer in most cases is slow-growing and contained within the gland.

The only way to find out if a tumor is elevating your PSA is to undergo a biopsy that involves 12 needles randomly inserted into the prostate in search of potential disease.

The traditional ultrasound technology used to guide needle biopsies generates only a two-dimensional image, which means that physicians can see the prostate, but not any tumors that might be inside it.

Prostate cancer is the only solid organ tumor usually diagnosed by a sight unseen, hit-or-miss biopsy, and this relatively blind approach has the potential to miss aggressive cancers.

Targeted biopsy improves tumor detection

Improving the diagnosis and management of prostate cancer has required researchers to develop advanced imaging techniques and search for specific cancer biomarkers.

The goal is having tools that can distinguish men with aggressive forms of prostate cancer and need invasive treatments from those men who are at low risk and can forgo unnecessary treatments that can have significant side effects.

The latest advances in targeted prostate biopsy systems incorporate the 3-D imaging capabilities of magnetic resonance imaging, known as MRI, with the guidance technology of ultrasound.

The MRI displays a color 3-D image of the prostate, enabling the physician to view lesions while performing the procedure. Guided by ultrasound, the physician inserts biopsy needles into the tumor, ensuring tissues from all suspect areas are captured. UCI Health experts are using a new targeted prostate biopsy system called Artemis.

“When using the system, physicians can actually see the lesion for improved detection of significant prostate cancer,” says urologic oncologist Dr. Edward Uchio. This was the case for 57-year-old Paul Kroger, who had been advised to follow a “wait and see” approach to his initial prostate cancer diagnosis. Due to his family history, Kroger sought a second opinion and a prostate biopsy.

Using Artemis, Uchio discovered that Kroger’s cancer was more advanced than originally diagnosed.

A study published recently in Journal of the American Medical Association confirms that targeted biopsy technology offers more accurate detection of high-risk tumors. Uchio was not involved in that study.

Tailoring treatment to individual patients

Artemis records the location of any tumors detected in the initial biopsy. If the tumor is found to be low risk for developing aggressive prostate cancer, active surveillance is the standard treatment. Your PSA level will be checked every three to six months and your tumor will be re-biopsied at one- to three-year intervals.

The 3-D image generated by Artemis provides a map of the prostate, showing the tumor’s exact location, so that only two or three needles are required for future biopsies.

“Targeted biopsies, combined with newer genomic testing, enable us to tailor treatment to individual patient needs,” Uchio said.

“These advances in imaging equipment and molecular analysis have created the opportunity for patient-centered therapy planning that was not available in the past.”

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