Prostate Cancer Biopsy Technique Adds Information
Physicians Want To Give Accurate Prognosis
Physicians
may be better able to determine the prognosis of prostate cancer patients
by changing the location of biopsies they take to check for disease,
according to a report in the medical journal Cancer. 
New research finds biopsy
results from the side of the prostate with the most advanced tumors
are more closely linked to the chances of the cancer returning after
treatment than are biopsy results from all over the gland.
"In the old days,
we used to say you had cancer and that was the general information you
got," perhaps along with an analysis of how aggressive the cancer is,
says the study's co-author, Dr. Stephen Freedland, a clinical instructor
at Johns Hopkins University School of Medicine.
"What studies like
ours are saying is it's no longer acceptable to [just] say that," Dr.
Freedland says.
Biopsy
Result Guides Physician and Patient
Prostate cancer
is the most common cancer among men, excluding skin cancer. American
Cancer Society estimates for 2003 include 220,900 new cases
of prostate cancer in the US.
Year 2003 estimates
include 28,900 deaths occurring from prostate cancer in the US alone,
making it the second leading cause of cancer death in men.
In the new study,
researchers examined the medical records of 535 men who had their prostate
gland removed surgically between 1988 and 2002. The researchers
wanted to see how early biopsies predicted how the men fared later.
According to study
co-author Dr. Christopher Kane, an associate professor of urology at
the University of California at San Francisco, physicians typically
take 10 biopsies from each prostate cancer patient by sticking needles
into the prostate and pulling out thin "cores."
The process is quick
and painless because local anesthetic is given, Dr. Kane adds.
If cancer exists,
pathologists can measure how advanced it is and how aggressive the cells
appear to be.
A prostate gland
has two lobes, and the researchers found the number of "positive" biopsies
on the side with the highest degree of cancer is a better predictor
of future problems than the number of positive biopsies as a whole.
"The dominant tumor
tends to be driving patients' outcomes," Dr. Kane says.
While physicians
may not be able to immediately use the biopsy information to help them
decide which treatment to try, it should give patients a better idea
of their prognosis, Dr. Kane says.
It will also help physicians
understand which patients face the highest risk of recurrence and may
belong in research trials, he adds.
Biopsy
May Affect Treatment Choice
Dr. Lester Klein,
a urologist at Scripps Clinic in San Diego, says more research needs
to be done before physicians will accept the results.
But, he adds, the
research is important because physicians need more information when
they consider options for men with prostate cancer.
Physicians can choose
from a variety of treatments, but the side effects can include incontinence
and impotence. This leads many men to carefully consider their
choices.
"What we're trying
to figure out is which patients should be operated on and which shouldn't
be operated on," Dr. Klein says. "There's no use operating
on something if it's going to fail."
Radiation and surgery
remain the major treatments for prostate cancer, Dr. Klein says, and
patients make the final call.
Always consult your
physician for more information.
Prostate
Cancer Evaluation
If the result of
a digital rectal exam (DRE) or prosate-specific antigen (PSA) test is
unusual, a physician may repeat the tests or request an ultrasound and
other procedures.
These evaluation tools may include:
transrectal
ultrasound (TRUS) - a test using sound wave echoes to create
an image of the prostate gland to visually inspect for abnormal conditions
such as gland enlargement, nodules, penetration of tumor through capsule
of the gland, and/or invasion of seminal vesicles.
It may also be used for guidance of needle biopsies
of the prostate gland and/or guiding the nitrogen probes in cryosurgery.
computed
tomography scan (CT or CAT scan) - a diagnostic imaging procedure
that uses a combination of x-rays and computer technology to produce
cross-sectional images (often called slices), both horizontally and
vertically, of the body.
A CT scan shows detailed images of any part of the body,
including the bones, muscles, fat, and organs. CT scans are more detailed
than standard x-rays.
magnetic
resonance imaging (MRI) - a diagnostic procedure that uses
a combination of large magnets, radiofrequencies, and a computer to
produce detailed images of organs and structures within the body.
radionuclide bone scan - a nuclear imaging method that
helps to show whether the cancer has spread from the prostate gland
to the bones.
The procedure involves an injection of radioactive material
that helps to locate diseased bone cells throughout the entire body,
suggesting possible metastatic cancer.
lymph node
and/or prostate biopsy - a procedure in which tissue samples
are removed (with a needle or during surgery) from the body for examination
under a microscope; to determine if cancer or other abnormal cells are
present.
The diagnosis of cancer is confirmed only by a biopsy.
Always consult your physician for more information.
Online
Resources
American
Cancer Society
American
College of Sports Medicine
Healthfinder,
US Department of Health and Human Services (HHS)
Healthy
People 2010
National
Academy of Sports Medicine
National
Cancer Institute (NCI)
National
Institute on Aging Exercise Guide
National
Institutes of Health (NIH) |
