Further advances in imaging for the diagnosis and management of prostate cancer.
The challenge of managing prostate cancer in the modern era is to risk stratify patients so that they are neither under nor over-treated. New imaging techniques now allow specific localization of prostate cancers facilitating targeted biopsy and appropriate treatments.
Multiparametric prostate MRI scanning has increased the diagnostic accuracy for the detection of prostate cancer. It has decreased the number of negative prostate biopsies and is rapidly developing as a reliable, non-invasive means of monitoring men on active surveillance programs for low risk prostate cancers.
The technology provides high quality detailed images of the prostate and surrounding tissues and is calibrated to detect only clinically significant cancers.
Having identified an area of concern with multi-parametric MRI imaging it is possible to perform targeted biopsies.
MRI/Ultrasound Fusion Biopsy
While MRI guidance increases the diagnostic accuracy it is time consuming, expensive and uncomfortable for patients who need to lie on the MRI table for an extended period.
MRI/Ultrasound fusion biopsy is a new technology that incorporates MRI and GPS technology to superimpose the MRI image over a dynamic ultrasound scan. Computerised co-ordination of the images allows for accurate targeting of the MRI detected lesions.
Sophisticated multi-parametric MRI diagnosis and fusion biopsy is a highly expert-dependent service and needs to be performed by an experienced urologist working in collaboration with an MRI-trained radiologist.
Dr Katelaris and Dr Toos Sachinwalla have one of the largest experiences in Australia with multiparametric MRI diagnostic technology. They have been co-operating very closely in order to introduce this technology to appropriate patients.
Patients must be clinically assessed by Doctor Katelaris who will determine the need for MRI imaging and, in conjunction with Dr Sachinwalla, the need for guided biopsy.
Another significant advance in the staging of prostate cancer is the advent of PSMA PET-CT scanning.
PSMA is a protein specifically located on the surface of prostate cells that can be targeted using a Gallium-68 radiolabel. The radiolabel then lights up on PET-CT scanning showing the location of any prostate cancer cells in the body.
In certain men it identifies the presence of discrete prostate cancer cells allowing them to be targeted by stereotactic radiation therapy as an attempt to definitively eradicate recurrence.