Prostate Cancer: New Procedures for Diagnosis – and Cure
Here is some news that, before too long, some of you may be able to use. There is a new technique for diagnosing prostate cancer. It is being deployed on an experimental basis at the National Institutes of Health (NIH) in Washington, DC. And it works. I know. I am a guinea pig.
I am in my early sixties, and I have four children under the age of twelve. A maternal cousin died of prostate cancer – after having his prostate removed – when he was in his mid-sixties. After discovering that he had an elevated Prostate Specific Antigen (PSA), my brother had a biopsy; on the basis of what his physician found, he had his prostate surgically removed; and today, almost two decades thereafter, he is in fine fettle. So mindful of the fate that might be mine, I watch, I wait, and I read what the standard websites have to say on the question. I have no particular desire to die right now; I have even less desire to abandon my wife and children; and my wife seems to think that it might be a good thing if I were to hang around for a while.
Not long ago, my PSA, which was low, took a sudden jump. The websites – this one is a good place in which to start – indicate that this is a warning sign. If one’s PSA doubles in eighteen months, I learned, it may be an indicator not only that one has prostate cancer, but that the cancer is aggressive as well. The distinction matters. Something like 60% of men my age have prostate cancer. In most cases, however, it will take something like thirty years for it to become a threat to their health, and most of them will no longer then be around. But if one has aggressive cancer and it is not caught and dealt with forthwith, one is done for.
Unfortunately, diagnosis is not easy. The PSA test is unreliable. Among other things, it does not distinguish between slow-growing and aggressive cancer. The digital rectal exam is more indicative, but there are no nodules on the prostate that a physician can detect with his fingers until fairly late in the process of a cancer’s development.
Even more to the point, the process for taking a biopsy – the only procedure that can eventuate in a reliable diagnosis – is hit and miss. An ultrasound is taken to map the prostate of someone suspected of having cancer; it is then divided into twelve sectors; and the biopsy, guided by the ultrasound, takes a single sample from each of the twelve sectors. If the cancer is quite advanced – as was presumably the case with my cousin – the biopsy will catch it. If it is small and in its early stages, it can very easily be missed.
When my PSA took a jump, I called a distinguished urologist whom I have known since we were children. I laid out the family history, and I mentioned my PSA results. He consulted Dr. Peter A. Pinto at NIH, asked him what he recommended, and I was invited to assist him in his research by serving as a subject. In consequence, over Spring vacation, back in March, I spent two days in our nation’s capital, undergoing a set of procedures that will soon in all likelihood, I am told, be more generally available.
On day one, the staff at the Molecular Imaging Program subjected me to trans-rectal Magnetic Resource Imaging (MRI) with Gadolinium. This involves the insertion of an endorectal coil into the rectum, the inflation of a balloon to hold it steady, and the introduction of an intravenous contrast material into one’s veins. In the course of the MRI, one is slid into a machine that produces a powerful magnetic field – where, from time to time for about an hour, one is assaulted by radio frequency pulses. With the help of sophisticated software, the technicians who operate the machine con produce a detailed picture of the prostate. And here is the kicker – if you have cancer, it shows up as a splotch in the picture, and those working with these procedures can grade any splotches they see with an eye to the likelihood that they are cancerous.
If nothing suspicious is found in the course of the MRI, that is the end of the story. If, however, there are suspicious splotches, one returns to NIH on day two to have a biopsy, which was my fate. Using sophisticated software, the technicians initially map the picture of the prostate produced by the MRI onto the picture produced by ultrasound. Then, guided by these images, a surgeon, performing the biopsy, samples the precise places where the MRI found suspicious splotches. To supplement this procedure, he then performs an ordinary biopsy, taking samples from the twelve sectors into which the ultrasound divides the prostate.
The first set of procedures is not a joy, but they are considerably less unpleasant than a colonoscopy; the second set involves some discomfort, but, at NIH, they use novocaine to deaden the prostate and reduce the pain. In my case, the MRI team identified five suspicious patches – three of them moderately likely to be cancerous, two of them worrisome but much less likely to be malignant. The biopsy revealed two minuscule patches that were cancerous. Each made up something like 2% of the biological material in the particular sample taken. In neither case was there any indication that the cancer is aggressive.
So, in a year or so, I will undergo another trans-rectal MRI. If nothing has changed that will be the end of it. If the MRI indicates the existence of more suspicious patches or if the previously existing patches have gotten larger, I will undergo another biopsy. If and when they find aggressive cancer, I can opt for treatment – which is most likely to be either surgery or radiation.
In the last quarter-century, I was told while at NIH, there has been a dramatic drop in the number of deaths from prostate cancer. The reason appears to be that PSA testing, digital rectal testing, and biopsies – when these techniques are all in play – often enough enable physicians to detect aggressive prostate cancer early on. And, when early detection is followed by surgery or radiation, they can usually stop the cancer in its tracks.
The new techniques, being pioneered by Dr. Pinto and his team, promise to identify the tissue that is suspect and to enable those conducting biopsies to hone in on the suspect tissue. When these techniques are sanctioned for general use, they should make early diagnosis easy, and they should then dramatically reduce the number of deaths resulting from prostate cancer.
Believe it or not, some of our tax dollars are actually being put to good use.
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Comments:
Sep '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
New procedures for diagnosis is certainly good news. I remember my first physical after I turned 40. That is when I learned that "digital" doesn't necessarily mean that it is done on a computer.
Jul '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
I am 71 and underwent this same process with the result my prostrate was sown with about a hundred radioactive seeds in January. The first follow-up showed that my PSA number, which had been accelerating, dropped from 6.9 to 2.7. That was encouraging but still on the highish side, I was told. I will be tested again in about a month. I go to the cancer center at St. Joseph's Hospital in Hot Springs, Ark., not a place known as the cutting edge for much more than mud baths and therapeutic massages. I was not under the impression this is an experimental program, but then they don't tell you everything. Interestingly, there was a story in Britain the other day that said early testing for prostrate cancer didn't pay off in reduced mortality. I assume some costs/benefit bureaucratic committee of the sort Obama wants in this country arrived at this conclusion. It is a lie, of course, faithfully reported by the media.
Edited on April 14, 2011 at 3:30amDec '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Thanks for a great annecdote and for making a great point. With all the budget talk floating around, I think it's good to be able to tell the difference between good and bad programs so that the bad can be surgically removed on the grounds of merit or lack there of.
Glad to hear you got a positive diagnosis, and I wish you good health and many more years to fight the good fight.
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
I have read stories similar to the one you cite. That was apparently the standard opinion until about two years ago -- when someone examined the data for the last few decades in detail. The people I met in the Department of Urology at NIH had always believed that early diagnosis and treatment would reduce the death rate. They now claim vindication. And, as you point out, common sense would suggest as much.
Sep '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Speaking of being put to good use, as the 51 yr old father of 4 but only 2 are youngsters, my hat's off to you sir and here's to medical science, lets hope the creeping socialists do not nip it in the bud.
Dec '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
'my wife seems to think that it might be a good thing if I were to hang around for a while."
Do not but too much life insurance.
Jun '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Who would have guessed that we could do so much with huge magnets and radio frequencies? The magnificence of the creation of MRI is paralleled maybe only by the guy who figured out that we could use horses for glue.
Could you imagine that group of professors, sitting around some faculty lounge or hospital coffee room, trying to figure out how to get images inside the body. Suddenly, one turns to the others and interrupts the smoking of his pipe, "you know guys... I think we can use magnets to do this."
Truly amazing.
Edited on April 14, 2011 at 5:10amMar '11
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Paul A. Rahe:
Believe it or not, some of our tax dollars are actually being put to good use.
"Did NASA invent Magnetic Resonance Imaging (MRI)?
No, NASA did not invent MRI technology, but it has contributed to its advances over the years, and elements of NASA technology have been incorporated into MRI techniques. In the mid-1960s, as a prelude to NASA’s Apollo Program, the JPL developed the technology known as digital image processing to allow computer enhancement of Moon pictures. Digital image processing has found a broad array of other applications, particularly in the field of medicine, where it is employed to create and enhance images of the organs in the human body for diagnostic purposes. Two of these advanced body imaging techniques are CT/CATScan and Magnetic Resonance Imaging (MRI)."
Dr Rahe; I am grateful that you make the point about your personal well being getting bless by the technology we as Americans enjoy, but I was having little success on other posts over the last few months to convey the interconnectedness between intangible inspirations (space program) and realizable personal benefits. This aside of digital imaging processing is prevalent in lapraoscopic surgery to jet engine inspections.
Feb '11
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
I am glad for your good prognosis and I wish you the best of health.
Mar '11
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
The more addicted I become to Politics, the more I realize that our only hope lies in Science.
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
I'm also glad for the good prognosis and send many good wishes.
Jun '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Professor Rahe, this post may not have as broad interest as your other posts, but those of use who are interested are very interested. Been through much of the current drill myself and so this is very hopeful news. Congratulations on being admitted to the program and on the good prognosis.
The availability of this procedure is likely to be problematic however. Though the procedure is not at all "high-risk" and approval for wide-spread use should not be difficult, procedures deemed "investigational or experimental" are not covered by commercial insurance and Medicare. The target population is almost, by definition, those who are, or soon will be, no longer taxpayers and Medicare and Social Security recipients instead. You can be sure that the models exist to factor the cost of new procedures against the savings from avoiding that last decade of life.
Edited on April 14, 2011 at 12:22pmFeb '11
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Thanks for this informative post. I wish you all the best!
Oct '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Your Grace: I am 71 and underwent this same process with the result my prostrate was sown with about a hundred radioactive seeds in January...
Edited on Apr 13 at 06:30 pm
I'd not be overly concerned about the PSA numbers for the first year. I went thru this same proceedure in august and my PSA numbers were all over the charts for 6 months - up, don, up some more. I've been told this is normal due to the tissue kill. It takes a while for the PSA to get out of your system but eventually it should go below 1. Why not to 0 I don't know. Perhaps even with a totally dead prostate the PSA producing glands funtion minimally. Anyway, good luck!
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
Your Grace: I am 71 and underwent this same process with the result my prostrate was sown with about a hundred radioactive seeds in January. The first follow-up showed that my PSA number, which had been accelerating, dropped from 6.9 to 2.7. That was encouraging but still on the highish side, I was told. I will be tested again in about a month. I go to the cancer center at St. Joseph's Hospital in Hot Springs, Ark., not a place known as the cutting edge for much more than mud baths and therapeutic massages. I was not under the impression this is an experimental program, but then they don't tell you everything. Interestingly, there was a story in Britain the other day that said early testing for prostrate cancer didn't pay off in reduced mortality. I assume some costs/benefit bureaucratic committee of the sort Obama wants in this country arrived at this conclusion. It is a lie, of course, faithfully reported by the media. · Apr 13 at 6:24pm
Edited on Apr 13 at 06:30 pm
Good luck with the treatment.
May '10
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
As George Will says, there is a solid role for the federal government in basic research. My job is supporting fundamental research of this type, al level that simply does not often get done at the intensity needed (due to our bodies' infinite complexity) in the commercial marketplace. There are serious policy changes needed, as well as little-noted patent revisions, to enable true progress. The pharma business model is dead for more reasons than drug cost.
As with most of DoD, the budgets of NIH are a bargain.
There is no reason that this kind of procedure could not be affordable to deliver. Basic MRI principles are off-patent, and the coils are not hard to make; the biggest cost is the proprietary operating software of GE and Siemens as applied in their business models. There is no reason that you could not have a high-volume retail screening operation for prostate MRI just as with mammograms, the way LASIK took over the retail market. Old guys like me would b e glad to pay a couple of hundred bucks to have a reliable exam.
Prostate cancer hits every man, due to biology- some at 50, others at 150.
Mar '11
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
MRI technology was derived from the use of magnets to gain information about chemical compounds; the technology is known as Nuclear Magnetic Resonance and gives a 2D graph that is specific for a particular compound, particularly looking at Hydrogen atoms. Using powerful Math and even more powerful magnets, that same resonance picture was made into a 3D representation of the body. It is quite amazing.
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
It is, indeed, amazing.
Re: Prostate Cancer: New Procedures for Diagnosis – and Cure
You are absolutely right. This will be commonplace before we know it.