Doctors routinely check the prostate gland in males during annual physicals. For those who don’t know the routine, it’s the part when the doctor puts on a plastic glove, says bend over, and performs a digital rectal exam.
This momentary uncomfortable experience is accompanied by a blood test called a PSA (prostate-specific-antigen) to detect that substance which is produced by the prostate to indicate if cancer cells might be present.
For years my PSA reading has been in the normal range with readings less than (4.0 ng/ML) but recently at age 72, it jumped from a 6 to an 8. In 2012, I had a slightly elevated PSA, and my urologist performed a biopsy and found no cancer cells.
Now he wanted to do another one.
I became skeptical when a friend told me he already had three of these biopsies performed by the same doctor, and all were negative.
This didn’t make sense to me. I began researching other options and learned more than one million invasive prostate biopsies are performed in America every year but about 750,000 are negative, indicating that no cancer was found.
This shocking statistic led to additional research and I located the results of a December 2012 UCLA study (the first of its kind in the U.S.) published in the January issue of the Journal of Urology.
The UCLA study used a new prostate biopsy technique involving 171 men who had prior negative biopsies like mine but continued to experience elevated PSA readings.
Dr. Leonard S. Marks, a professor of urology at UCLA, noted that many men with negative biopsies but elevated PSA levels may still harbor malignant tumors missed by conventional methods.
“Early prostate cancer is difficult to image because of limited contrast between normal and malignant tissues within the prostate,” Marks’ said.
“Conventional biopsies are basically performed blindly because we can’t see what we are aiming for. Now with this new method which fuses MRI and ultrasound, we have the potential to see the prostate cancer and aim for it in a much more refined and rational manner.”
The traditional prostate biopsy method that is used today in America by the majority of urologists pose potential serious risks including infection, bleeding, and urine retention.
It’s a procedure that’s been around since the 1980’s, but I learned from the UCLA study that it often overdiagnoses low grade prostate lesions and underdiagnoses high-grade anterior ones.
Let me explain. During my biopsy in 2012, my doctor inserted a small biopsy needle through my rectum into my prostate gland and took several core samples but did not sample the anterior zone because systematic guided-needle biopsies of this area are not usually performed.
This conventional method is called transrectal-ultrasonography (TRUS) where sound waves from the probe are used to create images of your prostate on a video monitor, but as Dr. Marks said, “We can’t see what we are aiming for.”
When I returned to my urologist’s office armed with Dr. Marks’ new information, I said that from what I can tell, you are going to perform a “pin the tail on the donkey” procedure with no guarantee you can locate a tumor. He agreed.
But, when I asked for a referral to be tested with new (MRI) Magnetic Resonance Imaging technology at First Scan located in Omaha, Nebraska, to see whether a tumor was present or not, he quickly said, “Insurance won’t pay for it.”
He reluctantly agreed to contact First Scan for the MRI test, and then left the exam room without any further discussion. I just sat there and thought to myself, you mean to tell me Medicare and private insurance won’t pay the $595 fee to First Scan where they can accurately determine if I have cancer, yet they will pay my urologist much more for the “approved standard of today’s care” that is invasive, painful and can be highly inaccurate.
In other words, the insurance companies are calling the shots, and only pay for an antiquated procedure, but won’t pay for the new technology.
A new study from the Diagnostic Center for Disease in Sarasota, Florida, states that the current prostate biopsy method in the United States is a “two billion dollar industry where 70 to 80 percent of biopsies are performed unnecessarily and underestimate the risk that a routine prostate biopsy can spread cancer cells and may be the reason men have a recurrence of the disease many years later.”
This dramatic piece of evidence led me down a new path in my search for a better option than the one offered by my urologist. I went to First Scan in Omaha, located near the intersection of I-80 and highway 50.
The non-invasive and painless forty minute MRI procedure at First Scan revealed a highly suspicious malignancy in the anterior region of my prostate where the UCLA study reports that repeat blind (TRUS) biopsies miss potentially aggressive and dangerous cancers.
My urologist would not have found this cancer using the old standard method although the cancer would have remained in the prostate and continued to grow.
Fortunately, I located a Mayo Clinic trained urologist that uses the UCLA research method referred to as an MRI fusion-guided biopsy. He combined the software taken in the MRI procedure from my exam in Omaha so he could see the tumor on the screen as he pinpointed the anterior region and removed a small sample of the cancer cells.
The lab report indicated I had Stage One cancer with a Gleason Score of (3 + 3) or a 6. A score of 6 or below indicates that I am not in immediate danger. I accepted my doctor’s recommendation that we do nothing now. He put me on an active surveillance program to monitor the tumor since we know the location.
He recommended that we send the sample for further testing. The Oncotype DX prostate cancer test he suggested is intended to be used for men recently diagnosed with early stage prostate cancer.
The test looks at the activity of certain genes in your tumor in order to provide personalized information about how aggressive your cancer is. The Gleason score alone cannot determine and predict how likely it is your prostate cancer will grow and spread.
My DX test results indicated my cancer was the very slow growing type.
In the UCLA study, prostate cancer was found in 53 percent of the 171 study volunteers. Of those tumors found using the fusion biopsy technique I had elected, 38 percent had a Gleason score of greater than 7, indicating an aggressive tumor and one more likely to spread than a tumor with lower scores.
The report stated, “Once prostate cancer spreads, it’s much more difficult to treat, and survival decreases.”
Based on my personal experience, here are three important implications one should consider before agreeing to undergo the standard prostate biopsy procedure used by the majority of urologists.
First, active surveillance is the most appropriate management strategy for many men with prostate cancer, but often this option is never mentioned.
Second, non-invasive MRI screening (even though insurance does not pay for it) reliably detects whether a tumor is present and minimizes unnecessary radical prosectomy operations that can cause incontinence, nerve tissue damage, urinary and sexual dysfunction.
Third, early detection of serious and aggressive cancers in the hard to locate anterior zone of the prostate will save lives.
Remember, you must be the captain of your own ship when making decisions about your health because it’s your life that is at stake.
