The Role of MRI in Matching Prostate Cancer With the Best Treatment

In December, an article I co-authored was published online by the American Roentgen Ray Society. It is an important piece on the role of MRI (Magnetic Resonance Imaging) in identifying and treating early stage prostate cancer patients while greatly reducing or even eliminating the risk of damaging side effects from radical surgery.

Radical prostatectomy is frequently recommended to prostate cancer patients with low-risk disease. Because so many centers offer robotic-assisted surgery, many patients believe that there will be no side effects. While an experienced robotic surgeon will generally have lower rates of long-term incontinence and impotence, patients who have robotic surgery are often shocked and dismayed to find that in the short term- even up to a year-they experience urine leakage and erectile dysfunction requiring  a program of penile rehabilitation to avoid loss of length and girth.

Because of this, surgical removal may constitute overtreatment for those with only one small tumor location.  As countless patients have heard me say, "It's like going after a mouse with an elephant gun." This is why I am passionate about matching the treatment to the patient.  This is where MRI comes in.

The article, "Role of MRI in Minimally Invasive Focal Ablative Therapy for Prostate Cancer," was published online in December, 2011 by the American Journal of Roentgenology. In it, my colleagues and I lay out four areas in which MRI supports targeted detection and treatment options: 1) identify appropriate candidates for a focal or "lumpectomy" approach to treatment; 2) guide minimally invasive ablative therapies in real time; 3) evaluate the effectiveness of ablation therapy shortly after treatment; and 4) assess any residual or recurrent tumor after ablation therapy.

As many as one-third of prostate cancer patients may qualify for a non-surgical ablation treatment (destruction) of tumor. Minimally invasive ablation technologies have demonstrated equal success in controlling prostate cancer, but with a minimal-to-no risk of incontinence and impotence, the most feared side effects. Ablation can be targeted and delivered with extreme cold (cryotherapy) or extreme heat (high intensity focused ultrasound or HIFU, laser, and vascular targeted photodynamic therapy).

If you are one of the growing community of educated patients, I encourage you to read the full article. I find that educated patients are empowered patients. I would be happy to have a copy emailed to you if you drop me a line at drscionti@yahoo.com. If you prefer, you can order it directly from the website. However, because the article is published in a clinical journal, you must pay a one-time .00 fee which gives you 1-day access to a pdf copy for printing. You can obtain it at http://www.ajronline.org/content/197/1/W90.full.pdf+html.

It is my sincere hope that the field of urology embraces MRI as a blessing to prostate cancer patients. For those urologists who don't have access themselves to MRI technology, I envision the day-hopefully soon-when we team up with radiologists who are experts in prostate MRI, so patients everywhere can know accurately the extent of their cancer, and the most appropriate treatment option.