Retired businessman Richard Bolton knew he might have a prostate problem when he received a prostate specific antigen test result of 4.0 in 2007.
Biopsies in 2007 and 2009 showed no evidence of cancer as his PSA results rose to 6.8 then 8.0 and dropped again. But the presence of prostate cancer was confirmed after he underwent an examination with a new prostate fusion biopsy technology at North Shore-LIJ Hospital this year.
“I am the face today of prostate cancer. I didn’t want to be here. But there it is,” the 61-year-old Point Lookout resident said at a North Shore-LIJ press conference about the new prostate cancer detection technology last week.
Dr. Art Rastinehad, director of interventional urologic oncology at LIJ Medical Center and North Shore-LIJ’s Arthur Smith Institute of Urology, said the newly developed UroNav Fusion Biopsy System, developed through a collaboration between Invivo, a subsidiary of Philips Healthcare and the National Institutes of Health, marks a major change in the detection of prostate cancer.
“I believe this is going to be the future of prostate biopsies,” Rastinehad said.
The new UroNav system combines MRI and ultrasound imaging, aligning overlaid images from both to more readily identify areas not revealed by the standard 12-core biopsy procedure. The 12-core biopsy procedure randomly samples tissue from different areas of the prostate. The combination of magnetic resonance imaging and ultrasound enables a 3D imaging to permit evaluation of the entire prostate.
In Bolton’s case, Rastinehad was able to identify a tumor that had been growing undetected on the surface of his patient’s prostate. He said the previous biopsies Bolton underwent sampled less than one-half of 1 percent of his prostate tissue.
“He’d be going on and his cancer would still be growing untreated,” Rastinehad said.
Rasitinehad said the UroNav system has been used in clinical trials at North Shore-LIJ since March 2012, with a demonstrated difference in results from MRIs, which he said produce results indicating no cancer in 33 percent of men with high PSA counts. He said among the 100 patients he has examined with the new imaging system, he has treated five patients who previously showed no evidence of cancer in biopsy results. Based on the clinical trial, he said an additional 37 to 45 percent of cancers were detected in patients who previously showed negative results from biopsies.
“All imaging is not created equally. Our goal here is to create a new way to screen for prostate cancer,” Rastinehad said.
He gray scale ultrasound imaging procuces “significantly less resolution” than an MRI. But the combination of both technologies in the imaging overlay technique enabled by the UroNav machine can localize and “sample” specific areas of the prostate. Rastinehad said the technique entails insertion of a probe in the patient’s rectum, which Bolton described as “uncomfortable.”
Bolton said he has fourth stage prostate cancer and is currently receiving radiation treatment.
Rastinehad said the new system has yielded a 40 percent relative increase in the detection of cancer. And he said earlier detection of prostate cancer enables doctors to track its development and affords a potentially greater number of treatment options.
Over eight years of pre-clinical and clinical studies at the National Institutes of Health in Bethesda, Md., Rastinehad said 900 cases of prostate cancer had been detected.
The UroNav machine is now commercially available at a cost between $150,000 and $180,000 to be interfaced with existing ultrasound machines in physicians’ offices.
Dr. Manish Vira, director of the Smith Institute’s Urologic Oncology Fellowship Program, said an estimated 240,000 men in the U.S. will be diagnosed with prostate cancer this year. He said 30,000 men will die from it, as it currently ranks second as the leading cause of death among adult males.
He said PSA tests afford a 30 percent chance of detection for a disease which frequently evidences no overt symptoms.
“The biggest challenge we have is early detection of prostate cancer,” Vira said.
