The diagnosis and treatment of prostate cancer (PCa) is currently undergoing a revolution similar to that seen over the past three decades with respect to the improvements made in breast cancer screening, diagnosis and treatment options. The long-standing gold standard for PCa diagnosis is the Transrectal Ultrasound (TRUS) guided prostate needle biopsy. While TRUS is still used to make an initial diagnosis, in recent years, the development of a staging prostate biopsy – the Transperineal 3D Mapping Biopsy – has been introduced, allowing physicians to better understand the stage and gravity of the cancer in order to make more informed treatment decisions.
“We have been working hard to bring prostate cancer diagnosis and treatment to more advanced states. Our approach follows similar efforts from breast cancer patients and advocates, which have led to the decline of radical mastectomies, an increase in research and better diagnostic test, treatment and surgical options,” said Dr. E. David Crawford, Chairman, Prostate Conditions Education Council and Professor of Urology and Radiation Oncology, University of Colorado.
Experts agree that prostate staging biopsies will yield better understanding of the extent and aggressiveness of the disease in patients. This information allows physicians to develop individualized treatment plans for patients. “We expect to see a decline in the number of men who are undergoing unnecessary prostatectomies or radiotherapy,” said Dr. Crawford. “This, coupled with new focalized treatments that are the equivalent of the ‘male lumpectomy’ should help us see an increase in positive outcomes for men diagnosed with the disease.”
Prostate Mapping Biopsy vs. TRUS
The TRUS needle biopsy is an outpatient surgical procedure in which a transrectal ultrasound is used to create an image of the prostate, allowing a physician to guide a small needle to take 6-12 samples of prostate tissue to test for abnormal cells and tissue. For many years, it has been the definitive way to diagnose prostate cancer. But under- and over- grading of the cancer is common. This can lead to patients undergoing treatments that are unnecessarily invasive or being subjected to the risk of associated morbidities from other treatment methods.
The Prostate Staging Biopsies (PSB) Procedure is performed as an outpatient procedure under general anesthesia. It allows physicians to create a three-dimensional image of the prostate, including the location of the cancer within the organ. As PSB can better determine the size and location of the cancer, it allows patients and their physicians to more appropriately select a treatment option, including ongoing evaluation.
In a recent study, 215 men underwent PSB. Of those, only 38 chose to have radical prostatectomy, while the majority of the remaining men underwent targeted therapy and 44 elected to watch and wait.
No studies have reported a significant difference in the risks or complications between the two procedures.
“The Prostate Cancer Staging procedure helped me to better understand the extent of my prostate cancer and to make a treatment decision based on more complete information than I otherwise would have had,” said patient Larry Biro. “For me and my family, it was an invaluable tool that addressed many of the normally unanswered questions that men in my position have.”
Prostate Cancer is the Second Leading Cause of Cancer Deaths in American Men; Enormous Economic Impact for Patients
Prostate cancer is the number two cause of cancer deaths in American men. According to the National Cancer Institute, there were an estimated 217,730 new diagnoses and 32,050 deaths from prostate cancer in the United States in 2010. One in six men over age 40 will develop prostate cancer. It is typically diagnosed in men over the age 65, and African-American men are in the highest risk group.
According to the National Institutes of Health, the U.S. expenditure for prostate cancer care was expected to be $12 billion, making it the fifth most costly type of cancer behind breast ($16.5B), colorectal ($14.14B), lymphoma ($12.14B) and lung ($12.12B) cancers.
About Prostate Conditions Education Council (PCEC)
A national organization committed to men’s health, the Prostate Conditions Education Council (prostateconditions.org) – formally the Prostate Cancer Education Council – is the nation’s leading resource for information on prostate health. The PCEC is dedicated to saving lives through awareness and the education of men, the women in their lives, as well as the medical community about prostate cancer prevalence, the importance of early detection, and available treatment options, as well as other men’s health issues. The Council – comprised of a consortium of leading physicians, health educators, scientists and prostate cancer advocates – aims to conduct nationwide screenings for men and perform research that will aid in the detection and treatment of prostate conditions.
 Al B. Barqawi MD, Kyle O. Rove MD, Saeed Gholizadeh, Colin I. OʼDonnell MS, Hari Koul PhD, E. David Crawford MD, The Role of 3-Dimensional Mapping Biopsy in Decision Making for Treatment of Apparent Early-Stage Prostate Cancer, page 3.
Al B. Barqawi MD, Kyle O. Rove MD, Saeed Gholizadeh, Colin I. OʼDonnell MS, Hari Koul PhD, E. David Crawford MD, The Role of 3-Dimensional Mapping Biopsy in Decision Making for Treatment of Apparent Early-Stage Prostate Cancer, page 7.
Kyle O. Rove, MD, Kathryn F. Sullivan, MD, E. David Crawford, M, High-intensity Focused Ultrasound: Ready for Primetime, page 1
National Cancer Institute Prostate Cancer Web Page.
National Institutes of Health, National Expenditures and Cost of Cancer Care for 2010