In 2018, the U.S. Preventive Services Task Force and a panel of international experts in the BMJ both recommended against routine testing for prostate cancer in men, citing that the benefit of the PSA testing is small, uncertain and there is harm associated with testing.
“While PSA-testing is not encouraged for all men, some men, such as those with a family history of prostate cancer may consider screening,” explains Rochester Regional Health urologist and robotic surgeon John Valvo, MD. “These men should talk to their doctors about the benefits of screening and possible harms. PSA-testing is controversial because while an elevated PSA is a reasonable red flag, it is not a sure sign that cancer is present. Prostate cancer requires a tissue diagnosis.”
Targeted Prostate Cancer Screening Via MRI
Because the traditional PSA test is not as reliable as needed, prostate cancer specialists across the country and here at Rochester Regional Health are moving towards a new approach – the use of objective observation via MRI-guided biopsies.
An MRI-guided biopsy allows the physician to take a sample of the suspicious-looking and specific section of the patient’s prostate cancer body tissue to confirm diagnosis before starting treatment.
“That’s the key going forward,” says Dr. Valvo. “In the past, we’ve had to make educated guesses at biopsying the right part of the tissue. But with new technology and higher-resolution MRIs, we can now target the areas of the prostate that are detected as harboring cancer and therefore target our therapies to those areas.”
Guiding Targeted Therapies for Prostate Cancer
By using MRI-guided biopsies to get a more accurate diagnosis, prostate cancer experts can now provide even more individualized treatments. The treatment for prostate cancer in the past has typically fallen into one of four buckets:
- Entirely removing the prostate
- Radiating the prostate
- Freezing the prostate tissue
- Using active surveillance or watching the prostate cancer and monitoring it closely for any changes
“With targeted diagnosis, we can now provide treatment directly to the specific area of the prostate that contains cancer,” Dr. Valvo explains.
One of the ways to provide that treatment that Rochester Regional Health experts are exploring, is the use of high-intensity focused ultrasound (HIFU). HIFU focuses beams of ultrasound directly to the areas where cancer has been detected, heating and destroying the targeted portion of the tissue. It is a minimally invasive treatment option that improves survival while also having shorter recovery time and fewer side effects than more traditional approaches.
As a treatment for prostate cancer, HIFU is a newer option in the United States, although it has been used for more than 15 years in Europe with positive results. At Rochester Regional Health, we’ve been testing the approach for about a year and a half and currently offer HIFU as a treatment option.
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