By: Dan Sperling, MD
Bertrand Russell, a British philosopher, wrote, “The only thing that will redeem mankind is cooperation.” Having recently had the honor of serving as a Guest Faculty member at NYU Urology’s course on advanced prostate imaging and focal ablation, I’ll paraphrase his words: The only thing that will redeem the world of prostate cancer patients is cooperation between radiology and urology.
As a radiologist, I am fortunate to have access to the most advanced prostate imaging: multiparametric MRI (mpMRI) under a powerful 3T magnet, which reveals different tissue functions to distinguish healthy tissue from tumors. A radiologist’s specialized training and experience allows him or her to interpret these functional high resolution images of a patient’s prostate gland and any suspicious areas within it. On the other hand, urologists are adept at using ultrasound imaging, a technology much more portable and less expensive than MRI—but which cannot give the same pictorial information because it can’t clearly distinguish suspicious areas. So how can urologists obtain the same information as radiologists?
The annual course offered by NYU is called “Advances in Prostate Imaging and Ablative Treatment of Prostate Cancer” and is specifically aimed at urologists. Many attendees were impressed at the breakthrough prostate MRI images. Until recently, diagnosing and treating prostate cancer was almost exclusively the “turf” of urology. However, word began to spread among patients that the TRUS biopsy performed by urologists often missed or underestimated cancer—not to mention the risk of infection—so patients began looking for an alternative. As advanced MRI imaging caught on, they sought out radiologists who offer 3T mpMRI as an intermediary step between an elevated blood test and a prostate biopsy.
On the other hand, the majority of imaging radiologists are not prepared to treat prostate cancer. That has been, and largely remains, the bailiwick of urologists, whose “menu” of treatments now includes radical prostatectomy, robotic surgeries, and ablation (tumor destruction) using minimal-to-noninvasive devices that generate extreme heat or cold to destroy tissue.
With the combined trends in improved imaging and innovations in ablation, the time is ripe for cooperation between imaging radiology and interventive urology in order to bring the best of both worlds together. In fact, breakthrough software is able to “fuse” advanced MRI images with the urologist’s in-office ultrasound to help a urologist perform a targeted approach to biopsy, similar to what I can do under real-time MRI in my radiology suite. Thus, fusion imaging is a metaphor of cooperation between radiology (MRI) and urology (ultrasound).
To make it more than a metaphor, the NYU course Director, Dr. Herbert Lepor, spoke frequently of the need for radiologists and urologist to work together closely as a team. In fact, the Sperling Prostate Center is collaborating with NYU Urology on a prospective (pre-defined) clinical study of focal laser ablation (FLA). Cooperation is unquestionably in the best interests of patients, as both specialties strive to improve prostate cancer outcomes. Bringing the best of radiologic imaging together with the best of urologic ablation will also be a way to keep medical costs down—something that benefits all of us.