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Low Risk Prostate Ca Not Always Low Risk

The criteria for active surveillance — often called “watch and wait” — in dealing with prostate cancer should be re-evaluated. That is the recommendation of a study done at the University of California, Los Angeles and published in the May 19th 2014 issue of the peer-reviewed Journal of Urology.

A release from the university notes that more and more men who believe they have low-risk prostate cancers are opting for active surveillance, forgoing treatment and monitoring the cancer closely with prostate-specific antigen (PSA) tests, digital rectal exams and ultrasounds at regular intervals to see if their tumors are growing. Nearly 400 men are now enrolled in the UCLA Active Surveillance program, the largest in Southern California.

However, according to the current UCLA study, selection of men for active surveillance should be based not on the widely used conventional biopsy, but with a new, image-guided targeted prostate biopsy. The new biopsy method, pioneered by a multi-disciplinary team on the Westwood campus, is now a routine part of the UCLA active surveillance program.

UCLA researchers found that conventional “blind” biopsy failed to reveal the true extent of presumed low-risk prostate cancers, and that when targeted biopsy was used, more than a third of these men had more aggressive cancers than they thought. Their aggressive cancers were not detected by conventional blind biopsy using ultrasound alone, and the men were referred to UCLA’s active surveillance program thinking they were at no immediate risk.

The targeted biopsy method, under study at UCLA since 2009, is performed by combining magnetic resonance imaging (MRI) with real-time ultrasound, a method of fusion biopsy, in a device known as the Artemis. Previous work from UCLA demonstrated the value of the new procedure in finding cancers in men with rising PSA who had negative conventional biopsies. This study is the first to show the value of using it early in the selection process for men interested in active surveillance.

The release quotes study senior author Dr. Leonard Marks, a professor of urology and director of the UCLA Active Surveillance Program, as saying, “These findings are important as active surveillance is a growing trend in this country. It’s an excellent option for many men thought to have slow-growing cancers. But we show here that some men thought to be candidates for active surveillance based on conventional biopsies really are not good candidates.”

Marks and his team identified 113 men enrolled in the UCLA active surveillance program who met the criteria for having low-risk cancers based on conventional biopsies. Study volunteers underwent an MRI to visualize the prostate and any lesions. That information was then fed into the Artemis device, which fused the MRI pictures with real-time, three-dimensional ultrasound, allowing the urologist to visualize and target lesions during the biopsy.

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