Prostate cancer diagnosis with MRI. Precision medicine at last catches up in prostate tumor therapy. 2
MRI in prostate cancer diagnosis: prostate mri vs biopsy. MRI helps to avoid non-diagnostic and unnecessary biopsy. Multiparametric MRI of prostate must be done. Dr. Anton Titov, MD. So the diagnostics of prostate cancer recently has caught up with cancer diagnosis in other organs. The diagnostic progress has been made earlier in other organs. That allows more targeted diagnostics and more targeted cancer treatment. Dr. Mark Emberton, MD. Correct! And also, we have better risk stratification for prostate cancer. It’s a big word. But we used to make many errors in prostate cancer diagnosis. It meant that we were never really sure what cancer was in the prostate. So when we found a little bit of cancer in the prostate that was always possibility there could be more cancer. Therefore the prostate cancer treatment was done “just in case”. Now we can have extraordinary precision because we can identify the prostate carcinoma tumor. We can put the needle inside the tumor and get representative tissue. We can actually know exactly what’s in the prostate cancer. And so instead of saying, “I think you have a low-risk cancer, Sir”. We can now say, “I have a 95% certainty that you have a prostate cancer of this grade and volume”. So it’s the precision medicine now that makes all the difference in cancer diagnosis. If we were having a conversation about care, I would be able to say to you exactly what was in your prostate. We can have a rational discussion about how best to treat cancer. Whether to leave prostate cancer alone, whether to watch it very carefully. If we were going to treat cancer in the prostate, how we might approach the treatment. Dr. Anton Titov, MD. So this reflects the trend that cancer is many different diseases of distinct molecular characteristics. Therefore, to say, “You have cancer of this organ”, prostate cancer, in this case, is not sufficient anymore. Cancer diagnosis has to be sophisticated and diagnosed at the molecular level and at precise anatomical level. Dr. Mark Emberton, MD. Correct. So, the prostate gland anatomy we’ve talked about. We get really representative prostate tissue now during biopsy. We get also a lot of tissue. This means that we can subject that tissue to genetic testing, to molecular proliferation testing. We can test all new molecular cancer markers that are coming out now. We can subject lots of prostate gland tissue to genetic cancer tests. So historically, because you didn’t know where the cancer was, we used to spread the biopsy needles. If there was a cancer there, you’re lucky if you hit it once and you get a tiny bit of tissue. Now we know where prostate cancer is exactly. So you fire needles at it. So instead of giving one millimeter of cancer to the pathologist, we can now give a centimeter or two centimeters of cancer to pathologist. That allows us to undertake all these new genetic cancer tests. Dr. Anton Titov, MD. You have already elaborated on that. But this is precisely the role for MRI in guiding prostate cancer biopsy. Mark Emberton, MD. Correct. MRI gives us what has been missing for hundred years. It is a cancer location inside prostate gland. Then we can use and exploit cancer location in two ways. One method is to do the biopsy in the MRI magnet. Some people are doing that. But MRI is a very tight space. There’s not a lot of space inside MRI to work in. MRI time in most countries is in short supply. Most MRI scanners are full. So prostate biopsy inside MRI is quite challenging. If you have an abundance of MRI scanners, which they do in some countries, particularly in Japan, and maybe in some cities within Europe. Most of us are taking the information from MRI. We then use computer science to re-register MRI information on the ultrasound. You know, we could have an ultrasound in this room, one we’re speaking in. You don’t need any special equipment. But we certainly couldn’t have an MRI scanner in this room. Dr. Mark Emberton, MD. And then you use the ultrasound scan and then merge the MRI information onto the ultrasound scan. This gives you all the information about prostate cancer in real time in your office. And so that’s the way that most of us are going prostate cancer diagnosis. That’s called image to image co-registration. There are about 7 or 8, maybe even 9 companies now offering commercial solutions for urologists and oncologists to get information location from one platform to another. Dr. Anton Titov, MD. So this helps precise diagnosis. Therefore, it helps to identify a precise prostate cancer treatment plan for that patient. Dr. Mark Emberton, MD. Correct!
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