How Has Prostate Cancer Biopsy Advanced with Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • GPS Guided Biopsies offer greater accuracy in detecting and determining the type of prostate cancer, as they can pinpoint the growth more precisely than a regular biopsy.
  • High-quality T3 MRIs, molecular biopsies, and patient follow-up allow urologists to monitor the cancer closely and make better-informed decisions about the need for aggressive treatment.
  • Urologists use tools like rectal exams and prostate-specific androgen (PSA) tests to monitor the progression of prostate cancer and recommend surgery or radiation therapy if the cancer becomes aggressive.

Prostate cancer is one of the most common forms of cancer found in men. The likelihood of it forming in the walnut-shaped prostate organ increases with age. Luckily, there have been many major advances in how prostate cancer is diagnosed and treated. When it comes to diagnosing, board-certified urologist Dr. Jonathan Jay says, “First we must define where it is, how much of it exists within your prostate, and then what its behavior is like.”

Answering the where, how, and what is key to determining the type of prostate cancer and how to watch or treat it. Urologists are using advanced technologies to answer these questions. Urologists want to know how aggressive a cancer is when determining how aggressively they need to treat it. They can use a molecular biopsy and a high-quality T3 MRI to pick up on aggressive cancers. If an aggressive cancer is found, urologists can perform a more focused biopsy.

Dr. Jonathan Jay - Naples, FLThis focused biopsy is called a GPS Guided Biopsy and it has some very important advantages over a regular biopsy. The cancer may exist in a very small portion of the prostate, especially early on. This small cancer can be missed during a biopsy just by a sampling error, leading to a diagnosis that may not give a completely accurate picture of the cancer. But with a high-quality MRI, a guided biopsy can pinpoint the growth and the urologist can detect and determine the type of cancer with greater accuracy.

When the cancer is detected with greater accuracy, the urologist can now follow it more closely and understand what type the doctor and patient are dealing with. The urologist can perform a biopsy on the cancer to look at and understand its genetics. If the genetics show that it is not very aggressive or growing, then the urologist may decide to watch the cancer, as treatment may not be necessary. MRI’s and patient follow up can be used to watch the growth to see if there are any changes that may require more aggressive treatment.

Along with MRI’s, the cancer can be monitored with rectal exams and prostate-specific androgens (PSA) tests. These tools offer insight into the patient’s specific prostate cancer and its progression. If it becomes aggressive, the urologist can recommend surgery or radiation therapy.

A diagnosis is the beginning of a patient’s cancer treatment. At the Advance Urology Institute, urologists like Dr. Jonathan Jay utilize recent advancements in prostate cancer biopsies to provide their patients with the most accurate diagnosis and best treatment options.

TRANSCRIPTION: 

I’m Jonathan Jay, I’m a board certified urologist with Advanced Urology Institute.

One thing I’ve always said about prostate cancer, one you’ve got to be able to define where it is, how much of it exists within your prostate and then what its behavior is like.

So if we take that molecular biology and now we have MRI, T3 weighted MRI that can pick up aggressive prostate cancers and we do what we call GPS guided biopsy, a Euronav biopsy. So for instance, if I were sitting in this room and I’m the cancer, so this room is the prostate and I’m the cancer in the prostate, I could pass a needle through this room 15 times and miss me or just catch my baby toe. So I can miss the cancer just by sampling error. But if I had an MRI that said in this part of the room where I sit is an abnormality and it looks different than the other parts of the prostate and I focus on that, my ability to define and detect that cancer within that room is much higher. So we have the ability to do that. So not only did I detect the cancer in a much better way, but I have the ability now to follow the cancer. So if I biopsy that, look at the genetics of that cancer and it’s not very virulent, I can watch that cancer.

I got MRI which I can use to plot whether it changes in size or character. I can use the molecular biology to tell how fast it multiplies if it’s a virulent cancer. I’ve got PSA and I’ve got my rectal exam. So I’ve got three or four clinical tools for which I can follow that patient. We always talk about risk and benefit of treating any disease and we can watch this disease. If it shows that it’s being virulent or changing its character, then we can take the risk of having surgery or radiation. But we would not take that risk if it’s unnecessary if we saw something that was not changing much over time and a threat to the patient.

REFERENCES: 

Diagnosing Prostate Cancer

Prostate cancer is the most frequently diagnosed cancer for men, with nearly 10 percent of all men getting it in their senior years. About 99 percent of all prostate cancers occur in men over 50 years old, though younger men should not ignore its risk. While it is one of the most common cancers for men, it also has some of the best survival chances, with over 98 percent of all men diagnosed with prostate cancer surviving at least another five years. This is in part because most prostate cancers grow slowly, and also because there are a lot of simple techniques to notice and diagnose its presence. After diagnosis, there are many effective treatments; however, nearly one out of every 41 men will die from prostate cancer.

Just as women should regularly check their breasts for lumps, men also should check their groin areas. However, that is not commonly taught by most doctors to their male patients, so men should ask their doctors how to do self-examinations.

Other signs that men can check could include any one or more of the following:

  1. The need to urinate more frequently
  2. Difficulty in starting to urinate
  3. Having a weak urine flow (it seems to come out too slow)
  4. Needing to sometimes rush to the toilet
  5. Straining to urinate, feeling one’s bladder has not really emptied
  6. Blood in either your urine or semen (which means something serious!)

A patient with any one of these symptoms should discuss them with his doctor. If a man has more than one of the symptoms for a week or more, he should see a doctor as soon as possible to check on possible causes. There are also more potentially treatable physical problems not related to the prostate gland that might cause those problems. A general practitioner through some simple tests should be able to then know if a urologist would be required.

Those uncomfortable “digital” rectal exams (DRE) men are asked to undergo can also detect prostate cancer, as well as another non-cancerous condition that can cause an enlarged prostate (BPH). If a general practitioner detects something unusual from a DRE that seems to be prostate-related, a prostate-specific antigen (PSA) blood test usually will be ordered. PSA is a prostrate-made substance that will tend to increase when men have cancer, inflammation, or even a simple infection of the prostate gland. Medical specialists will know when the PSA counts require specialists like those at the Advanced Urology Institute to further examine the patient.

A urology clinic can do most, if not all the following tests to determine if prostate cancer is the problem. They can use a transrectal ultrasound to get an ultrasound picture of the prostate gland and surrounding tissues. X-rays can detect if a cancer has potentially spread in a visible way. If the urologists determine there clearly are issues with the prostate, they perform a biopsy to discover the grade of the cancer, to discover how potentially aggressive the cancer is. A transrectal magnetic resonance imaging (MRI) may be required since some types of prostate cancer can spread out of the prostate into surrounding tissues and bones. Bone scans also may be utilized. Genetic tests on the biopsied tissues will help determine how aggressive the cancer may be. The clinic may use other types of exams and tests, depending upon medical findings.

After the urologist has completed the medical evaluations, the chances of recovery, the prognosis, can be discussed with the patient as well as the treatment options. The board-certified specialists at various clinics of the Advanced Urology Institute have years of experience working with patients, giving them the best advice for each of their unique situations. For more information, visit the Advanced Urology Institute website.