Prostate cancer is one of the leading causes of cancer death in men in the U.S.., and here in Cuyahoga County, but until recently doctors didn’t have good tools to help detect and monitor the growth of tumors. Doctors and researchers are excited that magnetic resonance imaging, or MRI, is providing the breakthrough needed to bring prostate cancer diagnosis out of the dark ages.
Seventy-year-old Mentor resident, Terry Strong, was the first person in the Cleveland area to undergo a newly available procedure, at University Hospitals, which helped his cancer doctor determine that his prostate cancer was aggressive enough to require surgery.
Over the past four years, Strong has been to several different doctors and had multiple biopsies of his prostate. Some tests indicated he had cancer while others were inconclusive. Then Strong heard about a new test being used by Dr. Lee Ponsky, chief of the division of urologic oncology at University Hospitals.
“When I saw Dr. Ponsky he said 'you know Terry I think you are the perfect candidate for this new procedure we are developing here would you be interested.' I told him I would be interested in anything that could tell me if I have cancer for sure,” Strong said.
Until recently when a doctor suspected a man had prostate cancer the only option was a blind biopsy – meaning they would take several samples from areas of the prostate where cancer commonly shows up, often using an ultrasound image to help. This is what happened to Strong.
“The previous doctor was concerned that there may be some cancer in the prostate but they were not finding any high risk cancer in the prior biopsies – the standard kind of blind biopsy. He was sent to us and we imaged him on the MRI," Dr. Ponsky said.
While Strong was inside the MRI machine, the doctor extracted tissue samples from his prostate with the assistance of a radiologist in an adjacent room – monitoring the images coming from the MRI machine. The information from the images helped guide the needle to the exact spot that seemed to be suspicious.
“With the MRI now we have the ability to see if there is an area of concern to do a very targeted biopsy, which really makes more sense," said Dr. Ponsky.
He called targeted MRI biopsies one of the biggest advances in prostate cancer detection in the last several years. For Strong the test confirmed he did have an aggressive tumor in his prostate and he had surgery to remove his prostate.
“I’m not anxious to have the surgery but I also didn’t want cancer going on once you know for sure you have it," Strong said.
Large hospitals across the country and here in Cleveland have embraced using MRI in prostate cancer diagnosis. Dr. Andrew Stephenson, director for the Center of Urologic Oncology at Cleveland Clinic, said vast improvements in the resolution and quality of the images produced by this current generation of MRI machines led to the clinic using them since 2014. Prostate cancer is finally catching up with methods used to diagnose other types of cancer, Stephenson said.
“There are no other cancers that we commonly treat where imaging is not used in the diagnosis so prostate has been the outlier," he said.
Cleveland Clinic uses a process called Fusion MRI, where the static MRI image is taken first, then superimposed over the real-time ultrasound image
Dr. Stephenson argued that the fusion method is more cost effective because the patient is in and out of the MRI room much quicker. That sentiment was echoed by Emery School of Medicine oncologist, Dr. Chris Filson. Dr. Filson, who is currently researching the uses and benefits of MRI across the country, agreed the in-gantry MRI method just launched at University Hospitals is more expensive and will be harder to get insurance companies to pay for in most patients, but there are exceptions, he said.
“Patents who have had multiple negative biopsies previously, there should be strong consideration of an MRI guided biopsy," Dr. Filson said.
All of the experts agreed MRI has been a game changer in diagnosing aggressive prostate cancer and there is new research moving it a step further. The new push is for scans to be used earlier in the process as a weeding out tool, so that many men can avoid having biopsies altogether.
A new study from a group of British researchers suggest that just by incorporating the use of MRI into routine screening of men would not only reduce their risks associated with surgery – it could also reduce the numbers of biopsies they would need.
The study published in January in the medical journal Lancet, estimates 1 in 4 men with suspected prostate cancer could avoid an unnecessary biopsy if given an MRI scan first. And according to the stud, MRI use could reduce the number of men who are over-diagnosed, meaning they were diagnosed with a cancer that does not go on to cause any harm during their lifetime, by some 5 percent.
