June is Men’s Health Month -- 30 days dedicated to encouraging men to be more proactive about their physical well-being. If you’re older than 40, this take-charge approach to your healthcare may include scheduling a prostate screening.
“The risk of prostate cancer increases with age, and is higher in men with a family history of prostate cancer,” explained Joseph Harryhill, MD, Clinical Associate Professor of Urology in Surgery at Penn Medicine. “African-American men may also be at an increased risk.”
The American Cancer Society recommends men with a family history and increased risk of prostate cancer talk with their doctors about prostate screenings as soon as they turn 40, while those with average risk can wait until age 50.
Spotting Prostate Cancer Early
Prostate cancer is difficult to spot early because most men do not show any signs of the disease. However, there are ways to diagnose it now that weren’t available before.
“Early prostate cancer is often silent, and does not produce any symptoms; thus, early detection for men at risk of prostate cancer requires laboratory testing with a prostate-specific antigen (PSA) blood test and digital rectal examination (DRE).,” Dr. Harryhill said. “Men who complain of bothersome urinary symptoms should be evaluated for the possibility of prostate cancer, as well.”
Prostate cancer was previously diagnosed by performing random biopsies on men who were at risk. Since the sample was random, there was a chance that testing could miss a significant cancer, while still picking up on slow-growing, non-life-threatening tumors. This put patients at risk of receiving improper treatment and care for the dangerous tumors or unnecessary biopsies with added stress and worriment for less-aggressive tumors.
New Technology, Improved Accuracy
Fortunately, the new MRI/Ultrasound Fusion Biopsy procedure at Penn Medicine is helping to correct these issues for better diagnosis.
“Now, with improved imaging technology with MRI, we can obtain more targeted biopsies of the prostate to improve our accuracy in diagnosing cancer,” explained Dr. Harryhill.
In the first step of the procedure, the patient receives an MRI, which is read by a radiologist. The radiologist marks any suspicious lesions using a process called segmenting.
"Prostate lesions are graded by a Prostate Imaging Reporting and Data System (PI-RADS) classification (1-5) by the radiologist, and if a high score lesion is present (especially PI-RADS 4 or 5), then in most cases a biopsy procedure will be recommended," said Dr. Harryhill.
Later, the patient returns to the urologist to be placed either under sedation or general anesthesia for a standard transrectal ultrasound procedure.
During the procedure, the MRI images -- including the location of the target lesion -- are fused together onto the real-time ultrasound screen imagine. Biopsies are obtained from the precise location in the prostate marked by the radiologist.
“In some cases, it may not be necessary to perform a biopsy if the MRI does not show any suspicious areas,” noted Dr. Harryhill.
The procedure typically takes 30-45 minutes on an out-patient basis with very little discomfort afterwards.
Who is a candidate?
Dr. Harryhill recommends an MRI/Ultrasound Fusion Biopsy for patients who have undergone a previous prostate biopsy that was negative for cancer but have PSA levels that continue to rise. Patients who have been diagnosed with prostate cancer and are on “active surveillance” to check if they need more biopsies to monitor the progression of the disease could also benefit from the procedure.
Ready to take advantage of Penn Medicine’s new state-of-the-art procedure? Request an appointment today or learn more at PennMedicine.org/Prevention