The title question is a decoy. Here’s the real issue: How important is your body? The more you value your body’s health, the more it’s worth seeing the best expert available if something goes wrong.

It’s like anything you love, appreciate and value. When all is well, we tend to take for granted that matters will continue on an even keel. However, we have far more dismay and worry if, say, a dear friend becomes ill than if a work acquaintance were to develop the same disease. The quality of care afforded to that friend suddenly matters, and only the best will reassure us of high chances for cure.

Your prostate is a dear friend of your sexual and urinary systems. When everything is working in apple-pie order, we don’t trouble ourselves with worry. However, if there is suspicion of prostate cancer, the humble walnut-sized gland deserves the best available diagnosis and treatment.

Today’s prostate cancer landscape is not the same as it was in your father’s lifetime. The biggest single breakthrough in transforming the field of prostate cancer (PCa) is imaging technology—specifically, multiparametric MRI (mpMRI). Not only does mpMRI help avoid unnecessary biopsies when no significant PCa is visible, it enables precise targeting if revealing significant PCa indicates need for a biopsy. Furthermore, if PCa is found and the patient is a candidate for a focal treatment (which eliminates the cancer while preserving healthy prostate tissue and function), real-time MRI guidance assures the most accurate, verifiable treatment with Focal Laser Ablation.

In-bore is the best, but there’s a catch

The expression “in-bore” means that live, real-time MRI is revealing the tumor and guiding the intervention, whether biopsy or FLA. Ultrasound cannot reveal what MRI can: the location, size, shape and extent of significant PCa. (Fusion-guided interventions use live ultrasound but do NOT use live MRI, so it’s misleading to call them “MRI-guided” as some physicians do.) Studies show that In-bore biopsies “detected more aggressive cancers and fewer indolent cancers than fusion (where software blends MRI and ultrasound images) biopsies.”^[i] I emphasize the word LIVE. As prostate cancer expert Dr. Mark Scholz explains, “…While you’re in the MRI, the needle is directed to the appropriate area with a robotic device.”

The same is true for FLA. While the patient lies in the MRI bore (tunnel), the laser fiber is guided into place and confirmed by real-time imaging. Then, in real time, special software tracks the temperature and extent of the tumor destruction as it’s occurring, and confirms the death of the tumor when it’s over. Live, and in real time! But here’s the catch.

Not all in-bore interventions are created equal. Just because a radiologist has the equipment, and has gone through some training, does not mean he or she is delivering the best procedure with the best results. Dr. Scholz underscores the importance of “skillful implementation: doctors who have done this a lot and know what they’re doing.”^[ii]

Experience is the best teacher, and those practitioners who have done hundreds and hundreds of in-bore biopsies are not only better at biopsy, but they have the greatest foundation for applying that hands-on expertise to FLA.

Here’s my recipe for top-shelf in-bore prostate procedures:
✓ One or more expert radiologists who specialize in mpMRI of the prostate
✓ One state-of-the-art 3T magnet (powerful magnetic field = very high definition)
✓ Two or more team members (technicians, nurses) with prostate experience
✓ A generous helping of site staff and administrators to reassure patients and keep workflow efficient yet empathic
✓ Hundreds and hundreds of previous procedures
Mix well, and continue to implement.

I believe that our Center’s unified experience justly earns our status in the forefront of in-bore biopsies and real-time MRI-guided FLA. When you want the best for your prostate, turn to the Sperling Prostate Center.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Costa A, Goldberg K, de Leon AD, Lotan Y et al. Magnetic Resonance Imaging-guided In-bore and Magnetic Resonance Imaging-transrectal Ultrasound Fusion Targeted Prostate Biopsies: An Adjusted Comparison of Clinically Significant Prostate Cancer Detection Rate. Eur Urol Oncol. 2019 Jul;2(4):397-404.
[ii] Mark Scholz MD. “Five Uses for MRI In Prostate Cancer | Prostate Cancer Staging Guide” Video posted July 3, 2018. https://www.youtube.com/watch?v=usugy3SIE1s