The History Of Prostate Cancer Diagnosis

Prostate cancer is the most common cancer in the United States for men, and the second most common cause of cancer death in men. In 2016 over 230,000 men will be diagnosed with prostate cancer and over 35,000 men will die of prostate cancer. 

Over the past 25 years the diagnosis of prostate cancer has progressed through 3 stages. The first method of diagnosing prostate cancer dates to the beginning of the last century. Diagnosis of prostate cancer required detection of an abnormal area in the prostate noted by prostate examination and the finding of a hard area within the prostate

The second method of diagnosing prostate cancer began in the early 1990s with the discovery of PSA (Prostate Specific Antigen), an indication or marker for the possible existence of prostate cancer. Urologists began evaluating the prostate for the existence of prostate cancer with prostate ultrasound-guided biopsy. In this procedure, urologists use an ultrasound scanner to view the prostate on a monitor in real time. With ultrasound guidance, a needle is guided into the prostate to remove a “core” or small sliver of prostate tissue that can be examined. We use a map or “template” to sample key areas in the prostate where prostate cancers are usually found. In most cases, 10 to 12 cores of tissue are removed and sent to a pathology lab to be analyzed for the presence or absence of cancer. This technique was a major advancement in the early detection of prostate cancer. Currently over one million prostate biopsies are performed annually in the United States using ultrasound guidance. It is a common procedure and our group performs over 500 prostate biopsies per year. 

Although ultrasound-guided prostate biopsy was a major advance in our detection of prostate cancer, ultrasound imaging has limitations. A standard first-time biopsy will miss up to 35% of prostate cancers. 

Urologists have known for many years that prostate cancers can be visualized utilizing MRI (Magnetic Resonance Imaging). With research and evaluation, MRI reliability has significantly improved. The current technology allows sharp and detailed images of the prostate. The combination of imaging techniques is known as Multi-Parametric MRI. This is best performed utilizing powerful MRI imaging. Most MRIs are 1.5T. “T” means Tesla or the strength of the magnet. A 3T magnet increases the ability to visualize the abnormalities that need to be identified in order to find a prostate cancer. 

We needed a 3T magnet due to the imaging advantage over the 1.5T magnets in Charleston. The only group with a 3T MRI in the area that agreed to help us bring this technology to South Carolina was Imaging Specialists. They provided significant intellectual support and also made the financial commitment to purchase the software that will enable this procedure to be performed in Charleston. As a result, Lowcountry Urology now offers Prostate Cancer Diagnosis using MRI Fusion Targeted Biopsy using the UroNav ssytem by Invivo.