Prostate Cancer in the Crosshairs
Advanced technology helps SIU physicians focus prostate cancer care
Written by Steve Sandstrom • Photography by Jason Johnson
It’s an unfortunate irony: the small gland that allows a man to create life can sometimes lead to his own demise.
Slightly larger than a walnut, the prostate produces a liquid that combines with and carries sperm. Once a man has passed his reproductive prime, the prostate has the potential to become a different kind of loaded weapon. Metastatic prostate cancer is the second deadliest cancer among US men, behind lung cancer.
To the SIU School of Medicine urology team, the goal is to catch prostate problems early.
Shaheen Alanee, MD, joined the School of Medicine’s faculty in the summer of 2013 as an assistant professor of surgery. He’s the head of urology oncology care in the Department of Surgery’s Division of Urology. He treats the toughest cases of urologic cancers.
Though Dr. Alanee knows how to help men fight the enemy within, he’s aware of the odds against them. "Even with the best treatment, patients who develop metastatic prostate cancer usually become resistant to hormonal treatment within about two years," Dr. Alanee says. "Once they go on a second-line treatment, survival of metastatic prostate cancer can be prolonged by an average of only four months."
At SIU School of Medicine one new method of prostate cancer diagnosis is currently being used and a new method for prostate cancer treatment is being examined, offering men in the area more advanced treatments for diseases of prostate.
MRI vs. ultrasound
Visit SIU HealthCare/SIU School of Medicine’s YouTube Channel to view a video of Dr. Alanee discussing the MRI for prostate cancer. http://tinyurl.com/krca4vq
Ultrasound guides a standard biopsy of the prostate. The trouble with this method is that it is "blinded" — the ultrasound can’t tell whether a lesion on the organ is cancerous as it randomly samples a portion of the prostate. "There’s a 30 percent chance that a patient will have a more aggressive form of cancer within his prostate than the biopsy sample would indicate," Dr. Alanee says.
Instead of the blinded biopsy, SIU’s urology team is now using a new magnetic resonance imagery (MRI) on the prostate. An MRI can provide very clear soft-tissue details of the prostate, revealing lesions that the physicians can accurately target for a biopsy. Physicians graph the tumor’s size and depth, and the biopsy needle extracts a sample from the precise location.
The School of Medicine uses MRI protocols designed by a team of physician collaborators at Centre Hospitalier Regionale University in Lille, France and Memorial Sloan Kettering Cancer Center in New York. St. John’s Hospital is partnering with SIU Urology to provide this specialized imaging in Springfield and build the program. St. John’s radiologists Vincent Zata, MD, and Theodore Gleason, MD, measure the lesion and grade its likelihood of being cancerous with a much higher degree of certainty than can be done using other techniques. Dr. Alanee then uses the MRI images to target suspicious areas for the biopsy needle.
This new, more accurate, less invasive technology gives men with rising PSAs and previous negative biopsies better information to address their concerns. It also helps Dr. Alanee verify that the prostate does not contain more aggressive disease in patients with low volume prostate cancer that could be managed with observation.
"There is increasing evidence that using an MRI before a biopsy can accurately identify patients who require immediate biopsies and those who could be deferred," Dr. Alanee says. "The partnership with St. John’s radiology brings more accurate monitoring to the Springfield area. Our findings are already detecting cancer in areas a biopsy did not."
SIU Urology and St. John’s are currently planning the next step of treatment. The team is developing a program for advanced imaging and management of prostate cancer that will require new equipment for computerized guidance of prostate biopsies based on MRI results. The data will allow even more precise cancer targeting. It has the potential to reduce the number of prostate biopsies needed to make a diagnosis and allows for safe, conservative management of cases of low volume, low risk cancer tumors.
"The potential of MRI in prostate cancer detection and management seems unlimited," Dr. Zata says. "As the technology develops, more uses for MRI are being identified. It’s not too far in the future that we may be able to substitute prostate biopsy with a combination of blood tests and MRI imaging and save our patients the discomfort of an invasive procedure."
Kevin McVary, MD, chair of SIU’s Division of Urology, has brought another innovative procedure to SIU. Vapor therapy, while useful for benign conditions is also proving valuable to treat cancer.
Capitalizing on the greater precision of the MRI technology, Dr. McVary has begun a clinical trial using vapor therapy to treat BPH, an enlarged prostate.
Dr. Alanee believes the procedure could eventually prove useful in specific cases where cancer is isolated within the prostate and not too close to the rectum or other sensitive tissues. Collateral damage to nearby areas is a major drawback of traditional prostate surgery. This new treatment could limit such damage.
To treat BPH using vapor therapy, a dosage of steam is released to obliterate the obstructing part of the prostate. The steam energy is calibrated to flow only into the target area to avoid causing damage to adjoining tissues outside the prostate. The procedure has the potential to become a treatment for prostate cancer by ablating the cancer in the same manner it does for BPH.
As innovation continues at SIU School of Medicine, physicians will help men fight the second deadliest cancer among men and turn the odds in their favor.