Originally published 12/8/2014
The original blog below is one of our earliest. Despite many advances in treating prostate cancer (PCa), we’re proud that it still holds true.
What’s the perfect treatment for YOU? “Perfection” differs from one patient to another.
For some, it means goodbye-and-good-riddance to their PCa, even if they don’t return to baseline sexual function—as often happens with after prostatectomy.
For others, it means holding off on treatment by choosing Active Surveillance, though the tradeoff might be living with an undercurrent of anxiety over the cancer in their body.
Now there’s a new term, “right-sized treatment”, that captures the idea of individualized perfection.
Similar to the experience of Goldilocks in the story of the Three Bears, such a treatment is neither too big (overtreatment) or too small (undertreatment). For each individual the treatment approach must be “just right.”
How can a doctor and his patient be sure of the fit?
The factors we identified 9 years ago are the same today as they were then, except the technologies have developed further, PI-RADS has enhanced the predictive power of mpMRI, and the integration of Artificial Intelligence has boosted accuracy and efficiency.
To sum up, right-sizing today’s treatment to the disease enables each patient’s treatment to become as close to perfection as it gets.
Is there a perfect prostate cancer treatment? All of us—doctors and patients—wish it were so, but since all treatments (including focal laser ablation) have some risk, however small, there is a better question to ask. What is the perfect treatment for YOU? Which leads to another question: How can you be sure?
I have seen countless patients who have gone to great lengths to research all their treatment choices. Often, they are gung-ho when they begin their reading of books and online sites. At some point, they may have reached what I call “analysis paralysis” where they are simply overwhelmed. And all too often, they have jumped in to this process without the best possible knowledge about their disease.
There are two parts to discovering the perfect treatment for YOU:
- Know your disease as thoroughly as possible, and
- Know which treatment(s) match your disease.
Today there are diagnostic refinements that far outperform the traditional PSA blood test and digital rectal exam. Here are my recommendations for understanding how to base a treatment decision as close to perfection as possible:
- Imaging – Whether you’ve already had a biopsy or not, it’s essential to know the location, size and shape of any significant tumor (Gleason equal or greater than 7). We offer the best type of imaging for this information, a multiparametric MRI done on a 3T (3 Tesla) magnet.
- Biomarkers – Let’s face it, the PSA blood test is not specific for cancer. An elevated PSA can mean benign enlargement, and inflammation or infection, or result from an activity such as bike riding, sex, even a DRE done before the biopsy (does anybody even make that mistake anymore? I hope not!) There are better blood and urine tests available, and they can be the first step in deciding if multiparametric MRI is indicated prior to a biopsy.
- Biopsy – Conventional TRUS biopsies cannot be counted on for accurate diagnosis. They can miss cancer altogether, underestimate cancer by missing the aggressive cells, or overestimate cancer by harvesting insignificant disease. As for location, TRUS biopsies are prone to miss cancer in certain prostate zones. It is better to first obtain a 3T multiparametric MRI, then have an MRI-guided biopsy into the suspect area. This maximizes accurate diagnosis while minimizing the number of needles (and reducing the risk of infection).
- Genomics – There are scores of prostate cancer cell lines, and they don’t all behave the same way. If you’re concerned about whether you have a potentially deadly cell line, there are biomarkers at the molecular level that can indicate if treatment is indicated soon, or if you have the luxury of time. You can request a genetic analysis of the tissue obtained by biopsy.
Once you know the facts, you are in a good position to weigh treatment options. Does a radical (whole gland) look like it’s indicated? Do you have a type of cancer likely to resist radiation? Do you qualify for a focal treatment? These and other questions should be discussed with your doctor. Remember that all national prostate cancer organizations and foundations suggest getting at least one other professional opinion. At the Sperling Prostate Center, we often see patients who have been diagnosed, but use 3T multiparametric MRI for a second opinion—another great use for imaging.
You will know when a treatment feels RIGHT for you—you will feel it in your mind and in your gut. When that happens, you can make a PERFECT decision with the confidence that comes from knowing your cancer.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
