Management 2017-09-28T10:54:31+00:00

Management

Laser Prostate Centers of America is moving prostate cancer detection and treatment into the twenty-first century with the introduction of the latest in diagnostics and image-guidance.

Until recently, prostate cancer patients have been given limited options for detection and treatment due to the lack of good imaging techniques available. The TRUS method dating back to the 1980s — and commonly accepted by healthcare professionals — misses 50% of cancers, detects non-significant cancers in the prostate and can lead to under grading the cancer, overaggressive treatment or missing the clinically significant tumor. This is just an example of one of the shortcomings with current prostate treatment paradigm that needs to be tackled.

The positive news is that advances in imaging and smart technology has led to enhanced treatment options for this patient population. Magnetic resonance imaging (MRI) is a commonly known imaging technique that produces detailed pictures of the prostate and other parts of the body. With MRI and expert know-how to read and interpret the scans, a better standard of care is now within reach for all prostate cancer patients.

Multi-parametric MRI also known as mpMRI along with computer-aided detection (CAD) is a huge factor in the advancement of prostate care and the diagnosis of clinically significant prostate cancer, as it can identify cancer requiring treatment while avoiding the detection and subsequent unnecessary treatments for clinically insignificant lesions. In a TRUS biopsy, prostate tissue samples are taken from multiple locations (12-20 different sites), which could lead to complete misses, samples from less aggressive lesions or detection of clinically insignificant tumors. For this reason, the TRUS method has been referred to as a “blind biopsy” due to the blind fashion in which the samples are collected. MRI can be used to guide biopsies to avoid problems faced by TRUS and improve success rates of biopsies.With the help of MRI guidance, significant cancers can be treated appropriately without need for whole gland therapies.

It is time that the patient population facing prostate cancer, have access to the latest technology and diagnostics, that is currently available for patients with other tumors. For example, before computerized axial tomography (CT or CAT scans), ultrasound (sonography), magnetic resonance imaging (MRI) and positron emission tomography (PET scans), patients with abdominal symptoms were often subjected to exploratory surgery. A patient suffering from severe abdominal symptoms would have an exploratory laparotomy in which they undergo a major surgical operation to determine the cause of their symptoms. In the past, laparotomies were commonly performed to examine the organs and tissues within the abdomen. But gone are the days of these exploratory surgeries with long recovery periods with the advent of high resolution imaging like MRI and minimally-invasive devices like laparoscopes.

Today, doctors use CT scans and other imaging techniques to view a patient’s abdominal region and can diagnose the issue within minutes to inform the treatment process. This helps reduce unnecessary major operations and enables fast, accurate diagnosis for execution of a focused treatment plan.

Until recently, prostate cancer patients have been given limited options for detection and treatment due to the lack of good imaging techniques available. The TRUS method dating back to the 1980s — and commonly accepted by healthcare professionals — misses 50% of cancers, detects non-significant cancers in the prostate and can lead to under grading the cancer, overaggressive treatment or missing the clinically significant tumor. This is just an example of one of the shortcomings with current prostate treatment paradigm that needs to be tackled.

The positive news is that advances in imaging and smart technology has led to enhanced treatment options for this patient population. Magnetic resonance imaging (MRI) is a commonly known imaging technique that produces detailed pictures of the prostate and other parts of the body. With MRI and expert know-how to read and interpret the scans, a better standard of care is now within reach for all prostate cancer patients.

Multi-parametric MRI also known as mpMRI along with computer-aided detection (CAD) is a huge factor in the advancement of prostate care and the diagnosis of clinically significant prostate cancer, as it can identify cancer requiring treatment while avoiding the detection and subsequent unnecessary treatments for clinically insignificant lesions. In a TRUS biopsy, prostate tissue samples are taken from multiple locations (12-20 different sites), which could lead to complete misses, samples from less aggressive lesions or detection of clinically insignificant tumors. For this reason, the TRUS method has been referred to as a “blind biopsy” due to the blind fashion in which the samples are collected. MRI can be used to guide biopsies to avoid problems faced by TRUS and improve success rates of biopsies.With the help of MRI guidance, significant cancers can be treated appropriately without need for whole gland therapies.

It is time that the patient population facing prostate cancer, have access to the latest technology and diagnostics, that is currently available for patients with other tumors. For example, before computerized axial tomography (CT or CAT scans), ultrasound (sonography), magnetic resonance imaging (MRI) and positron emission tomography (PET scans), patients with abdominal symptoms were often subjected to exploratory surgery. A patient suffering from severe abdominal symptoms would have an exploratory laparotomy in which they undergo a major surgical operation to determine the cause of their symptoms. In the past, laparotomies were commonly performed to examine the organs and tissues within the abdomen. But gone are the days of these exploratory surgeries with long recovery periods with the advent of high resolution imaging like MRI and minimally-invasive devices like laparoscopes.

Today, doctors use CT scans and other imaging techniques to view a patient’s abdominal region and can diagnose the issue within minutes to inform the treatment process. This helps reduce unnecessary major operations and enables fast, accurate diagnosis for execution of a focused treatment plan.

Evolution of Cancer Treatment: Focal Treatment in Other Cancers

Today, focal treatments have become widely accepted for many types of cancer treatment. Take breast cancer for example. Before the 1970s, breast cancer patients were routinely subjected to a mastectomy, surgical removal of the entire breast. During the 1970s, clinical trials revealed that less extensive surgery, like a lumpectomy – removal of the tumor only — was equally effective in treatment of breast cancer in most women.

Similar to the trend from mastectomy to lumpectomy, kidney cancer has seen an evolution to focal treatments. Patients suffering from kidney cancer or renal cell carcinoma (RCC) historically underwent a nephrectomy, or removal of the whole kidney. However, with localized RCC, the survival rates are excellent for patients who undergo either a radical or partial nephrectomy or other focal treatment. In fact, there are now emerging studies that radical nephrectomy patients have a lower overall survival rate due to an increased rate of chronic renal insufficiency and related cardiovascular disease. As such, partial nephrectomy is now the procedure of choice in appropriate patients. Focal treatments including CT-guided cryoablation (also called cryotherapy or cryosurgery) and radiofrequency ablation (RFA) to treat the kidney tumor are also preferred options as they are minimally-invasive, performed under image-guidance and are extremely effective. Liver cancer too has seen a similar shift from surgical hepatectomy to image-guided focal treatment including embolization and radiofrequency ablation.

Today, focal treatments have become widely accepted for many types of cancer treatment. Take breast cancer for example. Before the 1970s, breast cancer patients were routinely subjected to a mastectomy, surgical removal of the entire breast. During the 1970s, clinical trials revealed that less extensive surgery, like a lumpectomy – removal of the tumor only — was equally effective in treatment of breast cancer in most women.

Similar to the trend from mastectomy to lumpectomy, kidney cancer has seen an evolution to focal treatments. Patients suffering from kidney cancer or renal cell carcinoma (RCC) historically underwent a nephrectomy, or removal of the whole kidney. However, with localized RCC, the survival rates are excellent for patients who undergo either a radical or partial nephrectomy or other focal treatment. In fact, there are now emerging studies that radical nephrectomy patients have a lower overall survival rate due to an increased rate of chronic renal insufficiency and related cardiovascular disease. As such, partial nephrectomy is now the procedure of choice in appropriate patients. Focal treatments including CT-guided cryoablation (also called cryotherapy or cryosurgery) and radiofrequency ablation (RFA) to treat the kidney tumor are also preferred options as they are minimally-invasive, performed under image-guidance and are extremely effective. Liver cancer too has seen a similar shift from surgical hepatectomy to image-guided focal treatment including embolization and radiofrequency ablation.

Future of Prostate Cancer Management

While prostate cancer treatment is lagging behind other cancer treatments, the standard of care and detection is finally shifting toward focal therapies such as focal laser ablation (FLA). There is growing consensus and clinical evidence for use of focal therapies like FLA for low grade prostate cancer. With proper imaging and treatment, we can detect clinically significant cancers and treat it without sacrificing the whole prostate gland. This leads to significantly lower risk of side effects than other treatment options.

Laser Prostate Centers of America is a catalyst in bringing the most-advanced and appropriate treatment for patients with prostate cancer to the forefront. Prostate cancer management can now be elevated to the level seen in other cancer treatments as we move toward detection with high resolution imaging and image-guided FLA as a primary treatment option.

While prostate cancer treatment is lagging behind other cancer treatments, the standard of care and detection is finally shifting toward focal therapies such as focal laser ablation (FLA). There is growing consensus and clinical evidence for use of focal therapies like FLA for low grade prostate cancer. With proper imaging and treatment, we can detect clinically significant cancers and treat it without sacrificing the whole prostate gland. This leads to significantly lower risk of side effects than other treatment options.

Laser Prostate Centers of America is a catalyst in bringing the most-advanced and appropriate treatment for patients with prostate cancer to the forefront. Prostate cancer management can now be elevated to the level seen in other cancer treatments as we move toward detection with high resolution imaging and image-guided FLA as a primary treatment option.

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