By Dr Peter Ng, Consultant Urologist
24 May 2009 - The treatment and management of prostate cancer remains one of the most challenging areas in medicine today. The disease knows no barriers and counts amongst its victims the likes of senator Bob Dole, Gulf War general Norman Swartzkoff, and former French president Francois Mitterand.
There is no area in urology that has undergone more intensive research over the last decade than improving the detection and cure of this disease. The key to success is early detection in order to offer radical therapy before the disease has spread, and imaging is the centrepiece of this strategy.
Traditionally, the transrectal ultrasound has been the imaging modality used in the diagnosis of prostate cancer. However, it is plagued with poor accuracy in diagnosis and determining the extent of the disease spread. It is also traumatic, with the need for a number of needle punctures through the rectum into the prostate gland as well as the repeat biopsies if the cancer is not picked up. All this is distressing, as well as risky, to the patient.
There is a recent trend towards imaging with MRI as an improvement over the transrectal ultrasound. Results from using 1.5T MRI have shown that the most recent high-resolution pelvic phased-array coils already provide excellent imaging of the prostate gland, improving accuracy for cancer detection and volume estimation. This accuracy has been confirmed with actual biopsy specimens.
The latest 3.0Tesla MRI scanner is much more powerful than the 1.5T version, thus accuracy will further improve these results. The more accurate imaging of the areas in the prostate gland that have the cancer allows more focused targeting of these areas with the needle biopsy, hence saving patients from the often multiple attempts at transrectally-guided biopsies of the prostate.
The detection of pelvic lymph nodes from spread of the prostate cancer is also enhanced with this new machine, hence the accurate staging of the cancer will also spare patients unnecessary surgery.
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