Prostate Cancer Detection and Treatment

Recent publications in the urologic literature support the use of MRI for prostate cancer detection and also for the evaluation of extent of local metastatic disease. Knowing the exact location, size, and even how aggressive the cancer is, gives valuable information to the treatment team and helps identify which patients might be candidates for focal therapy (with a laser) rather than whole gland therapy such as the traditional radiation or surgical removal of the prostate. Dr. Lander has been working in close collaboration for many years with Halo Imaging on a world class MRI program for prostate disease.
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At Halo Imaging, state-of-the-art MRI technology provides Dr. Lander’s patients with advanced tools that allow screening and early detection of prostate cancer. Research shows that standard office ultrasound guided biopsies miss as many as 30 – 35% of prostate cancers, while MRI guided biopsies miss only 3% of prostate cancers that are aggressive (Gleason score 7 or above).

Using advanced software and hardware, Dr. Lander’s patients with elevated PSA can undergo MRI evaluation to determine if they require a biopsy.If a biopsy is required, the biopsy can be done inside the MRI machine using mild sedation for comfort. An MRI compatible needle sleeve is gently introduced a few inches into the rectum and the MRI imaging process is used to precisely guide the biopsy needle into the target area where a few samples are taken. This TARGETED BIPOPSY is very different from the traditional office biopsy procedure where multiple random areas are biopsied requiring as many as 18 to 20 passes of the needle as opposed to just a few biopsies performed under MRI guidance. An MRI targeted biopsy is less traumatic and much more accurate.

MRI Guided Prostate Biopsies

The following patients may benefit from MRI guided prostate biopsies:

Suspicious Serum PSA

Patients with a suspicious serum PSA (sudden change, stepwise increase, or elevation above normal for age).

Abnormal Serum PSA

Patients with an abnormal serum PSA and a negative office based trans-rectal ultrasound guided (TRUS) biopsy

Proven Prostate Cancer From a TRUS Biopsy

Patients with proven prostate cancer from a TRUS biopsy to exclude additional cancer or extension of cancer outside the prostate gland.

MRI Guided Focal Laser Treatment of Prostate Cancer

The same MRI technology used in targeted biopsies can also be used in the treatment of prostate cancer. If lesions can be identified as cancer, then they can also be treated using laser energy to destroy the cancer and not harm the surrounding normal prostate tissue. Performed under sedation, focal laser ablation of localized prostate cancer is an alternative treatment in patients who are seeking options to radiation and radical prostatectomy. The treatment team at Halo has now collected data exceeding 10 years showing excellent results and safety using focal ablation of the prostate (just destroying the part of the prostate that is cancerous).

MRI guided laser ablation of prostate cancer technology is performed inside the MRI machine with real-time MRI based temperature mapping to protect collateral tissue and avoid complications such as impotence, incontinence, and rectal damage. The focal laser ablation procedure is offered as part of a single institution clinical trial. This procedure is IRB approved and is patient funded.

Patients who are seeking a minimally invasive approach to prostate cancer treatment may benefit. Also, select patients who have already been treated for prostate cancer with radiation therapy, cryo therapy, or HIFU ultrasound therapy and there is concern for persistence or recurrence of the prostate cancer may potentially benefit from MRI guided detection and treatment.