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Explore frequently asked questions on this page, and remember that we are just a phone call away if you have additional questions or concerns.
Some common reasons any patient would not be treated with FLA are: patient can’t go into an MRI because of incompatible implants or hardware; we can’t see the tumor on MRI; the tumor is spread beyond the prostate; there are too many clinically-significant cancerous lesions (more than 2); the tumors are so large that treating the whole gland makes more sense. There are more reasons, but they tend to be specific to patient situations.
Yes, a biopsy is necessary because not all suspicious lesions detected in the prostate by MRI are cancer. Published studies indicate 40-60% of suspicious lesions in MRI are cancer, whereas the rest may represent other causes such as inflammation from a recent infection. We need to make sure the lesion we are treating is truly cancer and not risk treating a “look-alike” and leaving the real tumor cells behind.
We do administer IV antibiotics, prior to procedure for both the biopsy and the ablation. This best practice follows the consensus, outlined in Guidelines for Adult Antibiotic Prophylaxis in IR Procedure JVIR November 2010.
Scarring should not be an issue for us. Sometimes there is some blood clot (hematoma) left in the prostate gland after biopsies that can make it look different on MRI. That can affect the ability to detect cancer in a diagnostic scan, but is not really an issue for scans done during MRI guided biopsy or ablation, where we already know where it is located.
FLA can help reduce symptoms of BPH (benign prostate hypertrophy) but it is not immediate. In fact, immediately it might make it a little worse because of inflammation from the procedure that may cause temporary swelling. Some patients (quarter to a third) may require a temporary urinary catheter if the swelling prevents them from urinating. This should go away in a few days. The relief of prostate hypertrophy symptoms can be seen gradually over the course of several months, which was noted anecdotally in these cases.
Endorectal coils could be part of diagnostic MRI’s of the prostate, but not used in MR guided biopsies or focal laser ablations. The treatment cannot have an endorectal coil because the targeting system and needles have to go via their own rectal probe. There would be no room for both the coil and our procedure apparatus.
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) -enlargement of the prostate.
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer1. In addition, various factors can cause a man’s PSA level to fluctuate. For example, a man’s PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs including finasteride and dutasteride, which are used to treat BPH—lower a man’s PSA level.
In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a man’s PSA level over time may also be a sign of prostate cancer.
1Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004;350(22):2239-2246.
- If the cancerous tissue looks much like normal prostate tissue, a grade of 1 is assigned.
- If the cancer cells and their growth patterns look very abnormal, a grade of 5 is assigned.
- Grades 2 through 4 have features in between these extremes.
Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score (also called the Gleason sum). The highest a Gleason score can be is 10.
The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7. Other ways that this Gleason score may be listed in your report are Gleason 7/10, Gleason 7 (3+4), or combined Gleason grade of 7.
If a tumor is all the same grade (for example, grade 3), then the Gleason score is reported as 3+3=6.