Prostate Cancer Diagnosis & Treatment

Prostate cancer has become one of the most common forms of cancer in American men, affecting one of every seven men, and is the second-leading cause of cancer death in this population. An elevated PSA blood test may indicate a malignancy within the prostate, but a high PSA value may be temporary and can be caused by non-cancerous conditions. It is important to note that not all men with prostate cancer have high PSA levels, and other factors may be just cause for early detection. 

Traditionally, evaluation of a suspicious prostate has been to perform a biopsy using an uncomfortable procedure called transrectal ultrasound-guided (TRUS) biopsy. However, there are insufficiencies with this method:

  • Because of poor image resolution, the tumors cannot actually be seen on ultrasound.
  • Because of this lack of visualization, multiple core samples are randomly taken from all areas of the prostate.
  • Significant discomfort and pain are associated with this process of taking multiple samples.
  • Even with a large number of core samples, the actual site of a tumor may be missed.
  • If multiple tumors are present, there is no differentiation between those that need aggressive treatment and those that need to be watched.

The new method is a diagnostic prostate MRI called multi-parametric magnetic resonance imaging (mpMRI). With this system, physicians first perform an MRI to determine if a prostate tumor actually exists. If the MRI indicates a need, several samples are taken of the specific site for biopsy, eliminating the need for multiple, painful biopsies.

Because of the new technologies that significantly reduce the insufficiencies of the TRUS biopsy, patients with elevated PSAs should be very proactive in the diagnosis of possible prostate cancer:

  • Insist on having a state-of-the-art, pain-free mpMRI before having a biopsy.
  • If the MRI indicates the need for a biopsy, insist on having a targeted MR/US fusion biopsy.
  • Call SIR at 941-378-3231 for more details, and schedule that first step—the mpMRI.

Diagnostic Prostate MRI

Prostate Cancer Diagnosis & Treatment

DynaTRIM and DynaCAD—complete clinical MR solution for the prostate

Multi-parametric magnetic resonance imaging (mpMRI) is new technology in MR imaging that has opened the doors for detection of prostate cancer. Sophisticated equipment designed to take detailed images of the prostate is now being utilized to identify specific areas of interest for targeted biopsy.

DynaTRIM®is a fully MRI-compatible device for transrectal interventional MRI (TRIM) imaging of the prostate gland. It is a removable device that attaches to the top of an MR imaging table and enables physicians to conduct targeted MRI interventions of suspicious areas within the prostate gland. DynaTRIM® features an open design that allows for flexibility in choice of imaging coils and also offers a cleanable foam pad for extra patient comfort.

Why DynaTRIM®?

  • It produces very clear images.
  • It can distinguish between benign and malignant areas.
  • It reduces the number of cores that would be taken if biopsy becomes necessary.

After the MRI, DynaCAD® for Prostate allows the interventional radiologist to perform real-time, comprehensive analyses of prostate MRI studies. This powerful, easy-to-navigate digital imaging system quickly processes and manages the numerous prostate images. This technology easily synchronizes patient studies for further review and then generates complete, extensive summary reports that highlight all crucial aspects of the study.

Using the combination of DynaTRIM® and DynaCAD® for Prostate, patients can have peace of mind if the MRI rules out prostate cancer.

MRI/Ultrasound Fusion Prostate Biopsy

Prostate Cancer Diagnosis & Treatment

UroNav biopsy system

The newest standard in the diagnosis of prostate cancer is the targeted MR/US biopsy, which fuses the pre-biopsy MR images with US-guided biopsy images in real time. SIR is one of the first outpatient facilities in the U.S. to install the UroNav® system for prostate biopsy, an MR-guided 3D fusion biopsy platform performed in the office using IV conscious sedation. This remarkable MR/US fusion technique produces excellent definition of the prostate and shows the exact location, shape, and size of the suspicious lesion.

Before the MR/US fusion biopsy, the patient must have an mpMRI of the prostate. Dr. Grubbs then reads the MRI images and produces a roadmap to pinpoint the suspicious lesion. During the MR/US fusion biopsy, the urologist uses the roadmap to guide the transrectal ultrasound probe to the targeted lesion, thus fusing MRI with ultrasound in real time. This provides a more accurate and safer way to biopsy the prostate than the formerly used transrectal ultrasound-guided biopsy alone.

Working closely with Dr. Grubbs at the SIR facility, 16 top local urologists are currently using this latest and safest technique for prostate biopsy. With the UroNav® system, they have had great success in identifying and staging prostate cancer.

MRI/US Fusion

UroNav simultaneously displays registered MR and US images and the projected needle path relative to the suspicious target lesion

Post-biopsy review provides the visualization and recording of target and biopsy core locations in multiple 2D and 3D views

Revolutionary Prostate Cancer Treatment

High Intensity Focused Ultrasound (HIFU)

If a diagnosis of prostate cancer is confirmed, the patient and his physician will want to discuss the available treatment options. Most current treatments have comparable results for non-return of the cancer, with those success rates ranging from 80-83%. However, erectile function and incontinence are factors the patient may want to take into consideration when deciding which treatment to select.

The latest advancement in treatment for prostate cancer is a minimally invasive technique called High Intensity Focused Ultrasound (HIFU), which is a groundbreaking therapy that represents a paradigm shift in the treatment of prostate cancer. HIFU uses the fused MR/ultrasound images to create a customized plan to deliver high-intensity ultrasound energy to the prostate. In this procedure, HIFU sends focused ultrasound waves that increase the temperature of the targeted tissue within seconds, resulting in destruction of the diseased tissue.

HIFU has significant advantages over traditional treatment methods:

  • It does not involve radiation or surgery.
  • It targets and destroys the diseased tissue but does not harm surrounding healthy tissue.
  • It has significantly better outcomes for maintaining erectile function and eliminating the potential for urinary leakage; specifically, the risk of impotence and incontinence is only 2-4% versus 40-60% with traditional surgery or radiation therapy.

HIFU may be focal, meaning that treatment involves only the cancerous part of the prostate, or it may be full gland, meaning that the prostate is treated in overlapping zones until the entire gland is completely ablated.

Dr. Grubbs works with local urologists in the tri-county area (Sarasota, Manatee, and Charlotte counties in Florida) to provide this treatment for prostate cancer patients.