Archive for August, 2012

The Case for Stereotactic Transperineal Prostate Biopsies

By Brian J. Moran, MD

 Today, approximately 240,000 men will be diagnosed with prostate cancer. There remains a large group of patients, however, that are undiagnosed with this disease despite having had transrectal prostate biopsy. It is not uncommon for an individual to have a rising PSA level despite having had negative prostate biopsies where no carcinoma was identified. Stereotactic Transperineal Prostate Biopsy (STPB) uses a perineal approach, where the needles are placed through the skin below the scrotum and in front of the anus, to obtain specimens from the prostate. Ultrasound guidance is used and the patient is anesthetized at the time of the procedure.

This technique has many advantages, the first of which is its increased ability to identify occult or “hiding cancers”. Our research and the research of others have clearly demonstrated that the transrectal biopsy does miss a significant percentage of cancers that occur in the anterior or front portion of the prostate. Our data in over 2,200 patients suggests that as high as 40% of patients are thought not to have malignancy, but indeed do have malignancy. Our group has previously published this information in Urology and the Journal of Urology. The second advantage to having a prostate biopsy using the perineal approach is that the infection rate is essentially 0%. This is simply because the rectal wall or rectum in general is not penetrated by the biopsy needle. As we know, infection is not uncommon after transrectal prostate biopsy and unfortunately the bacteria that are currently being identified have significant resistance to commonly used antibiotics. Our initial experience using STPB was confined primarily to patients who were diagnostic dilemmas in that they had persistent elevation of PSA level, while the biopsies were negative. More and more commonly today, patients are requesting perineal biopsy as their initial biopsy technique. This is because they have learned of the mapping ability using this procedure.

Specifically, the STPB is able to accurately identify the location within the prostate from which the cancer was obtained. This has dramatic implications because one is then allowed to apply therapy to only the area of malignancy, while avoiding normal sections of the prostate gland that have been proven NOT to contain malignancy. A whole new field of oncology will soon appear, and that is the realm of focal therapy for prostate cancer. Finally, due to the  comprehensive information that STPB establishes, one is able to make a decision as to whether watchful waiting is a viable option.  Watchful waiting is NO treatment of the cancer. Certainly this option is pursued by many individuals, however, with information based solely on transrectal prostate biopsy, one risks the possibility that a higher grade malignancy may also exist in the gland that was not identified. For these reasons, we think that STPB will definitely have a place in the future of prostate cancer diagnostics and therapeutics. With regard to prostate seed implants (brachytherapy), based on perineal biopsy data, there is no question that the implants today are much more sophisticated than those based on transrectal biopsies in the past.

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‘Genetic Score’ May Improve Prostate Cancer Prediction

Karim Karer, M.D., PhD, and other colleagues from Wake Forest University School of Medicine in Salem, NC, analyzed data from 1,654 men who were a part of a prostate cancer clinical trial. The men in the study all had multiple negative biopsies, PSA screenings and received a genetic score based on testing of a panel of 33 single nucleotide polymorphisms that had been previously associated with prostate cancer.

The researchers found that, after adjusting the clinical factors and family history, the genetic score was a significant factor of a subsequent positive biopsy.

“Adding genetic markers to clinical parameters may improve cancer risk prediction. The improvement is modest but maybe helpful for better determining the need for repeat prostate biopsy,” Kadar and colleagues conclude. “The clinical impact of these results requires further study.”

Most of these diagnoses are made with a standard transrectal biopsy administered in the office by urologists. However, often times a patient will have a continued rising PSA, despite having had a negative office biopsy. This causes anxiety for patients and physicians. Fortunately ChicagoProstateCenter has developed Stereotactic Transperineal Prostate Biopsy, or STPB. This is the most comprehensive, sophisticated prostate biopsy technique available, diagnosing 40% more cancer than the standard transrectal office procedure —- cancer that would have otherwise gone undetected. The STPB procedure:

  • Diagnosing 40% more cancer
  • One-time, out-patient procedure (no hospital stay needed)
  • Minimally invasive (no incisions or stitches)
  • Performed under general anesthesia with no discomfort
  • Infection rate negligible
  • Confidence in exact location of cancer
  • Minimal, if any, post-operative pain
  • Return to normal activity within a day

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Senator John Kerry Leads Unanimous Passage Of The Legislation In U.S. Senate Urging Federal Research Support To Improve Early Detection Of Prostate Cancer


U.S. Sen. John F. Kerry (D-MA) led unanimous passage of the Senate Resolution 493 to recognize prostate cancer as an epidemic striking African American men disproportionately, with 250% higher mortality and 60% higher incidence. This bipartisan legislation urges federal agencies to support research for the advancement of diagnostic tools, including novel biomarkers and imaging technologies. Improved diagnostic tools will save lives and assure individualized, the least invasive and the most cost-effective patient care in millions of American men.

Senator Kerry said, “Prostate cancer is an epidemic – it kills every 16 minutes. This disease killed my dad, but I was lucky to beat it ten years ago, I introduced this resolution in the Senate to bring attention to this silent killer, how it disproportionately affects African Americans, and the need for additional federal investment in prostate cancer research, education, and awareness. I’ve been through the battle against prostate cancer and I understand the strain a diagnosis places on the patient and their loved ones. We need to stay focused on research and arm Americans with the tools to prevent, detect, cure and treat this disease, and I’m grateful to my colleagues and our advocates for pushing this resolution through.”

Dr. Faina Shtern, President of AdMeTech Foundation who worked with Senator Kerry and his staff for several years on prostate cancer research funding issues commented, “We applaud Senator Kerry’s leadership in national recognition of prostate cancer as a public health priority and a health care crisis in African American men. This legislation offers hope to millions of men who are left in the state of shock and confusion by the recent recommendation of the US Preventive Services Task Force against PSA screening, the only diagnostic tool currently available for early detection. Ending PSA screening is not the answer to the prostate cancer crisis. The Kerry resolution in support of research to improve diagnostic tools is.”

Prostate cancer is the most common malignancy in the United States, but federal research support is lagging behind, and men do not have reliable diagnostic tools. The impact is sobering: While prostate cancer is curable when detected early, it remains the second most lethal cancer in men, killing over 30,000 men each year.

Boston-based AdMeTech Foundation is a non-profit organization providing international leadership in prostate cancer research, education, and awareness ( ).

SOURCE AdMeTech Foundation

CPC agrees with Senator John Kerry. Early detection prevents unnecessary deaths from prostate cancer.

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Prostate cancer study questions surgery

A study that was reported in the New England Journal of Medicine has doctors divided. The study consisted of 731 men with the average age of 67, with only 10 percent under the age of 60, the implications for younger men who have more potential years ahead of them are less certain, experts noted. Researchers divided the group of men in half. Half of the men were assigned to have surgery, while the other half were assigned to watchful waiting. The group that was being observed had PSA testing every six months and every five years they did a bone scan to check for tumor spread. After 12 years, 47% of men who was treated with surgery died, compared to 49.9% of the men who were assigned to watchful waiting. There is not a significant difference between both options.

Based on their findings, Dr. Timothy Wilt, lead author on the study, stated that “observation is a wise and right decision for men with prostate cancer detected by PSA.” The article also stated that Dr. Wilt said his study agreed with the recent recommendation by the United Stated Preventative Services Task Force that PSA testing should not be used for young healthy men.

CPC encourages men to consult with their physicians and to get all of the facts, treatment options and make an educated decision that will benefit the patient.

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