Overlake Medical Center, a nonprofit, 349-bed regional hospital and medical clinic network based in Bellevue, Washington, announced the adoption of a new standard of care for prostate cancers, with the potential to dramatically decrease the rate of over-treatment, including unnecessary surgeries. The revised protocols were made possible by new magnetic resonance imaging (MRI) technologies that improve the diagnostic accuracy of biopsies to more precisely identify cancer type and optimum treatment path for patients.
While cancer of the prostate is the most common form of cancer and the second-leading cause of cancer death in men, there is a wide range of severity, with some less aggressive and fast-growing than others. Consequently, treating all prostate cancers the same can lead to excessive treatment in some cases, with patients unnecessarily having to deal with potential side effects of radiation therapy or lasting quality-of-life issues, such as incontinence and erectile dysfunction, that frequently are associated with surgery.
“One in seven men will be diagnosed with prostate cancer during his lifetime, but not all prostate cancers require immediate treatment,” Dr. Khanh Pham, a urologic oncologist at Washington Urology Associates, said in an Overlake Hospital press release. “In the past it has been a challenge to distinguish between tumors that are potentially deadly and those that are indolent.”
“We are pleased that Overlake is at the forefront of care,” added Pham, an expert in robotic-assisted laparoscopic surgery for the treatment of prostate cancer and other urologic diseases. “Investing in technology that helps us better view high-grade tumors, as well as perform MRI-guided prostate biopsies, which both have huge positive ramifications for patient care.”
David Winokur, Overlake’s Medical Imaging director, said: “Typically, a patient may come in with elevated prostate-specific antigens (PSA) in their blood, but that number can be the result of anything from aggressive cancer to a simple infection, so an accurate diagnosis is crucial. MRI technology gives us the ability to view detailed cross-sectional images of the prostate and provide a much more accurate view of the type of tumor were dealing with.
“In addition, MRI-guided biopsies are a game changer,” Winokur continued. “We now have the ability to pinpoint exactly where the tumor is and biopsy the precise target rather than the traditional ‘shotgun approach’ of ultrasound guided biopsies.”
Earlier tools for diagnosing and categorizing prostate cancers were much more limited and imprecise, leading to patients and doctors opting to err on the side of caution and choosing more aggressive treatment than would otherwise have been indicated.
The American Cancer Society notes that because prostate cancer often grows very slowly and remains isolated in the prostate, some patients, particularly older men or those with other health problems, might never need treatment for their prostate cancers. Early studies of men on active surveillance indicated that only roughly one-third of them went on to require radiation or surgery.
“Patients need to fully educate themselves on their diagnosis and treatment options,” Pham said. “Guidelines from the American Cancer Society as well as the American Urological Association have evolved to include ‘active surveillance’ [also known as ‘watchful waiting’ or observation] as an acceptable and viable management option for men with low-grade, indolent prostate cancer.” Active surveillance involves monitoring the cancer closely, including a doctor visit with a PSA blood test and digital rectal exam (DRE) at approximately six-month intervals, and in some instances yearly prostate biopsies as well. If test results change, potential treatment options can be revisited.
Added Pham, “aggressive treatment, with either surgery or radiation therapy, still remains important in the management of prostate cancer for appropriately selected patients, but may not the best solution in many cases, and Overlake’s new standard of care reflects that.”
Overlake Medical Center
The American Cancer Society