By Dan Sperling, MD

In May, I attended the annual meeting of the American Urological Association in Atlanta, GA. I was struck by the diversity of opinion among urologists as to the merits of MRI imaging for tumor detection – let alone treatment! While I found a certain amount of skepticism, even negativity, there was more open-mindedness and scientific presentations on MRI than I had anticipated. Happily so, I might add, as urologists are beginning to encounter patient resistance to TRUS biopsy, and greater demand for “smart” or targeted biopsies.

The greatest convergence of opinion over MRI had to do with focal therapy, another area in which there is no meaningful clinical agreement. The ability of focal therapy to destroy prostate tumors while preserving urinary and sexual function is increasingly recognized as an alternative to whole-gland treatments under the right conditions. However, there is no universal protocol on how to identify which patients will benefit from focal treatment without being placed at risk for disease progression. Thus, increasing numbers of physicians are engaging in dialogue over developing such criteria.

Three respected urologists have recently published journal articles on the need for more precise imaging as essential for clinically qualifying an individual for focal treatment. They are John Ward, MD (MD Anderson Cancer Center), Osamu Ukimura, MD, PhD (USC Institute of Urology), and Inderbir Gill, MD (USC Urology). All of them are in favor of finding better ways to match the range of treatments with the spectrum of disease. In other words, they support focal treatment for the right patient under the right conditions. Ukimura and Gill recommend that urologists at least familiarize themselves with new imaging technologies. They point out:

These four leading-edge areas are the hallmark of my practice. My patients are able to take advantage of the specific kind of MRI-guided detection, treatment and follow-up that these experts affirm. In particular, their final point about “per lesion” active surveillance brings up an area I am passionate about: men’s health, and the connection between healthy lifestyle and cancer prevention. But that’s for another article.

For now, it’s enough to say that I’m grateful to such authors, whose work affirms my commitment and expertise in the use of MRI to detect, treat and monitor prostate tumors.