Don’t Let Confusion about False Positives Keep You from Getting an Annual Prostate Screening
One of the more common reasons men over 50 are hesitant to be screened for prostate cancer—the No. 1 cancer found in men—is the confusing news coming out about PSA testing, false positives, and unnecessary biopsies. That leaves men vulnerable. Dr. Richard Long uses new MRI technology to detect cancer—a technique that has vastly improved the accuracy of prostate cancer diagnoses and efficacy of treatment.
How does your practice differ from that of other physicians?
Our practice is part of a large, multispecialty cancer group—Diablo Valley Oncology, where we have developed a Prostate Cancer Center of Excellence. We are committed to offering the latest technologies and therapies for patients diagnosed with prostate cancer. o are the only group in the East Bay using a novel technique for detecting prostate cancer; it’s called the 3T MRI Ultrasound fusion guided prostate biopsy system. This technology helps minimize the chance for unnecessary or negative biopsies and increases the likelihood that we’re going to find clinically significant cancer that we want to be treating. It’s game-changing technology that most urology practices do not have. Even a lot of academic centers don’t have it.
How do you get more accurate results with MRI?
You still have to do a blood test and look at PSA (prostate specific antigen), which is higher in men with cancer. The problem is that PSA is not really specific to cancer. There are other conditions in the prostate—for example, infection that can cause the PSA to be elevated. So you’ll have false positives where you’re worried about the PSA, and then you go do a biopsy to try and find the cancer and you don’t find anything.
For most PSA blood tests that are less than 10 (nanograms of PSA per mililiter of blood)—which is still a high number—75 percent of the biopsies we do are negative. But we now have a specific MRI called a multiparametric, or 3T, MRI that uses a stronger MRI magnet. With that, we can detect abnormal tissue in the prostate. That’s something we’ve never been able to do before. 3T MRI can identify suspicious lesions and differentiate aggressive tumors from slow growing tumors. So if someone has an elevated PSA, rather than going directly to do what we call a blind biopsy—basically strafing the whole prostate with our needle, looking for the cancer because we can’t see it—we can look at the MRI and actually highlight spots that are of concern. If the MRI shows a slow growing tumor, we can avoid unnecessary biopsies and provide active surveillance for these patients.If the MRI detects a dangerous tumor, we have advanced software technology that takes the MRI images and electronically fuses them with ultrasound images obtained in real time in the office, which allows us to know the exact location of the aggressive tumor and perform a precisely targeted biopsy.
The bottom line is that we end up eliminating a lot of the biopsies that were going to be negative based on the PSA. The MRI now gives us an intermediary step between the PSA blood test and the biopsy and allows us to focus our attention on specific areas in the prostate.
What’s the main advantage for the patient?
The advantages to the patient are that fewer will end up having to go through biopsies, and the ones who do need a biopsy are more likely to have a clinically significant cancer that we really need to be treating rather than a low-grade cancer.
How were you treating these cases that shouldn’t have been treated?
First, patients with an elevated PSA were getting biopsied, the biopsies were negative for cancer, and so there was no treatment. But they had to go through a biopsy to figure that out. We are now able to minimize that number with 3T MRI.Secondly, with men who do have prostate cancer, there are several factors we look at specific to the cancer. The one really important factor is what’s called the Gleason Score. That’s a number assigned to the cancer that gives the treating physician an idea of how aggressive the cancer is. The higher the Gleason Score is, the more likely the cancer is to be aggressive and spread and be potentially life threatening. The lower that number the less likely that it needs to be treated because it may not be life threatening depending on the patient’s age or health.
By using the MRI, we’re more likely to diagnose the cancer with a higher Gleason Score. They’re more likely to be significant cancers that we need to be treating.
What are the concerns patients typically have when they come to you?
Initially, it may be that they’re having trouble urinating. A lot of patients are sent because their PSA blood test is high and they’re very anxious about the possibility of cancer. And so that’s a very emotional time for a lot of patients who are concerned about the decision of whether or not we need to do a biopsy. The MRI allows us to get more information before making these decisions.
What are some common misconceptions about prostate cancer?
That’s all over the board. On the one extreme you have patients who don’t want to see the doctor. They’ve heard that they don’t need to be screened for prostate cancer or have it treated if they have it. If men don’t get screened, it has the potential to take us back to the way things were prior to the late ’80s, when we were seeing more advanced cases of prostate cancer.
At the other end of the spectrum, you have patients who are so concerned about their diagnosis of prostate cancer that they’re worried they’re going to die tomorrow. But even with the most advanced cases of prostate cancer, patients can have significant life expectancy because it is a cancer that is a much slower growing tumor compared to other cancers. So, even in cases when we can’t cure the cancer, we oftentimes are able to control it for many years.
Annual PSA screening is very important—if it detects a rapid rise from one year to the next, a urology consult is recommended.
Pacific Urology, 100 N. Wiget Lane, Ste. 290, Walnut Creek, 925-937-7740, PacificUrology.com