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Early MRI may lower costs for prostate cancer treatment

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Study finds MRI and MRI-guided biopsy cheaper long-term than standard ultrasound.

A diagnostic MRI followed by one of three MRI-guided biopsy strategies is a cost-effective method to detect prostate cancer, according to a new study out of Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center. Researchers compared MR-guided approaches to the current standard of transrectal ultrasound guided biopsies and found that these approaches yielded net health benefits that were well within commonly accepted threshold for costs-benefit ratios and thus are cost-effective strategies for detecting prostate cancer. The paradigm-shifting research was published in the preeminent journal Radiology.

“Many consider MRIs to be cost-prohibitive, especially when evaluating for a common entity such as prostate cancer. This was our expectation as well, prior to doing this work, but our study found the opposite. We found that performing MRI before biopsy and using that information to alter biopsy pathways would be a strategy that would add health benefits to the patient population in a cost effective manner,” said Vikas Gulani, MD, PhD, study advisor and associate professor of radiology, urology, and biomedical engineering at Case Western Reserve University School of Medicine, and member of both the Case Comprehensive Cancer Center and Case Center for Imaging Research.

The study was jointly first-authored by Shivani Pahwa, MD, department of radiology, and Nicholas Schiltz, PhD, department of biostatistics; and was developed in close collaboration with Lee Ponsky, MD, department of urology, and Mark Griswold, PhD, department of radiology.

The researchers found using MRI to help detect lesions and guide biopsies increased standardized quality-adjusted life years for patients and was cost-effective in 94.05% of simulations. The benefits were consistent across age groups, and could change how doctors identify and sample cancer lesions.

The current standard of care for detecting prostate cancer involves 12 biopsy samples collected during an invasive transrectal ultrasound. Since most tumors are not visible on ultrasound, up to 40% of clinically significant tumors are missed via this method, and many found are clinically insignificant. The approach regularly results in patients entering treatment pathways with potential negative side effects, to treat low-risk tumors. Biopsies may also cause bleeding and complications, increasing health care costs.

MRI offers a non-invasive alternative to transrectal ultrasound which can help better steer biopsy pathways. Doctors could use MRI to evaluate patients for potentially harmful lesions, and then use that information in one of three MRI guided strategies for biopsying potential foci of cancer, and bypass biopsy if a scan is completely negative. Although scans are expensive, they can add health benefits by triaging patients into proper treatment pathways. MR tends to miss low risk cancer, the overtreatment of which is a major contributor to high health and financial costs in prostate cancer. Similarly, a negative MRI is a very good predictor of exclusion of aggressive disease. A combination of such factors is likely the reason for the cost effectiveness of the MRI guided strategies. Current estimates place prostate cancer care costs in the United States at over $10 billion annually, and the price tag is rising.

The findings may help streamline prostate cancer treatment protocols to better serve patients. Said Gulani, “Costs are escalating in part due to expensive and inefficient diagnostic pathways, and placement of patients in incorrect treatment groups. If we can maximize efficiency in how we identify clinically significant lesions and diagnose patients, we can reduce unnecessary treatments for our patients, and reduce costs to our hospitals.”

Source: Case Western Reserve University

URL: https://www.sciencedaily.com/releases/2017/05/170517154720.htm

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Prostate Cancer – Most common among males in India

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Prostate cancer is a cancer of the small, walnut-shaped gland near the urinary bladder in men, that produces seminal fluid, nourishes and transports the sperm. Located in front of the rectum and just below the bladder, where the urine is stored, the prostate also surrounds the urethra, the canal through which urine passes out of the body. Older men, usually in the sixth decade of their life, are at a higher risk of this disease.Symptoms

At the early stages of this cancer, most men will not experience any symptoms. Some men, however, will experience the following symptoms that might indicate the presence of prostate cancer:

  • Frequent urination, especially at night
  • Difficulty in starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hip or upper thigh

Causes

The exact cause of prostate cancer is under investigation. However, increasing age and high testosterone are known risk factors.Diagnosis

Since the above mentioned symptoms can potentially indicate the presence of other diseases or disorders, men who experience any of these symptoms should undergo a thorough check-up to determine the underlying cause of the symptoms.

  • A blood test for a protein known as Prostate Specific Antigen (PSA)
  • An ultrasound examination through the rectum is suggested, usually after the doctor has examined the prostate through the rectum (Digital Rectal Examination – DRE)

Treatment

The prostate cancer treatment options depend on several factors, such as:

  • How fast the cancer is growing
  • How much it has spread
  • The overall health
  • The benefits and the potential side effects of the treatment

Immediate treatment may not be necessary
For men diagnosed with a very early stage of prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance.

In active surveillance, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer. If tests show that cancer is progressing, then the doctor recommends surgery or radiation.

Active surveillance carries a risk that the cancer may grow and spread between checkups, making it less likely to be cured.

Radiation therapy
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:

External beam radiation: During external beam radiation therapy, the patient lies on a table while a machine moves around the body, directing high-powered energy beams to the cancer. The patient undergoes external beam radiation treatments five days a week for several weeks. External beam radiation uses x-rays or protons to deliver the radiation.

Brachytherapy: Brachytherapy involves placing many rice-sized radioactive seeds in the prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. The doctor implants the radioactive seeds in the prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don’t need to be removed.

Hormone therapy
Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:

  • Medications that stop the body from producing testosterone
  • Medications that block testosterone from reaching cancer cells
  • Surgery to remove the testicles (orchiectomy)

Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumours. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumours before radiation therapy. This can make it more likely that radiation therapy will be successful.

Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.

Surgery to remove the prostate
Surgery for prostate cancer involves removing the prostate gland, some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include:

  • Using a robot to assist with surgery
  • Making an incision in your abdomen
  • Making an incision between your anus and scrotum
  • Laparoscopic prostatectomy

Freezing prostate tissue
Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.

Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.

Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy.

Multiple new chemotherapy drugs have recently been approved for treatment of progressive, metastatic prostate cancer.

Immunotherapy
A form of immunotherapy has been developed to treat advanced, recurrent prostate cancer. This treatment takes some of the patient’s own immune cells, genetically engineers them to fight prostate cancer, and then injects the cells back into the patient’s body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple visits.

Management
Depending on the stage of the disease, hormonal therapy, surgery and/or radiation therapy are initiated. Some patients may require chemotherapy at a later stage.

Specialists:

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Dr Ravi B Diwakar – Medical Oncology (View Profile)

Dr S Bhattacharjee – Radiation Oncology (View Profile)

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Dr Sridhar P S – Radiation Oncology (View Profile)

Dr Vijay Agarwal – Medical Oncology (View Profile)

Dr Vinayak Maka – Medical Oncology(View Profile) 

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Prostate Cancer Symptoms..

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In most cases, prostate cancer symptoms are not apparent in the early stages of the disease. The symptoms of prostate cancer may be different for each man, and any one of these symptoms may be caused by other conditions. As a result, routine screenings in the form of digital rectal exams and prostate-specific androgen (PSA) tests are important.

Early warning signs of prostate cancer
Because of the proximity of the prostate gland to the bladder and urethra, prostate cancer may be accompanied by a variety of urinary symptoms, especially in the early stages. Depending on its size and location, a tumor may press on and constrict the urethra, inhibiting the flow of urine. Some early prostate cancer signs include:

Burning or pain during urination
Difficulty urinating, or trouble starting and stopping while urinating
More frequent urges to urinate at night
Loss of bladder control
Decreased flow or velocity of urine stream
Blood in urine (hematuria)
Blood in semen
Difficulty getting an erection (erectile dysfunction)
Painful ejaculation
Prostate cancer may spread (metastasize) and form tumors in nearby organs or bones. If the cancer spreads to the spine, it may press on the spinal nerves. Signs of metastatic prostate cancer may include:

Swelling in legs or pelvic area
Numbness or pain in the hips, legs or feet
Bone pain that doesn’t go away, or leads to fractures
The symptoms of prostate cancer often differ from patient to patient. The most common first sign of recurrent prostate cancer is a rise in the PSA level in the blood, making regular PSA tests all the more important in measuring the progress of treatment and checking for signs of recurrence. It is important to report new signs or symptoms to your doctor.
Prostate specific antigen test
A prostate-specific antigen (PSA) test measures the level of PSA in the blood. The prostate gland produces PSA, a protein that at an elevated level may be a sign of prostate cancer. A high PSA reading also may indicate noncancerous conditions such as inflammation of the prostate (prostatitis) and enlargement of the prostate (benign prostatic hyperplasia).

Men who have symptoms associated with prostate cancer may have a PSA test along with a digital rectum exam (DRE). These symptoms include burning or pain during urination, loss of bladder control, painful ejaculation, and swelling in legs or pelvic area. For the test, a clinician takes a sample of your blood and sends it to a lab for analysis.

In the past, a PSA reading of 4 ng/mL and below was considered normal. Men with a reading above 4 ng/mL were considered likely to have prostate cancer and would have a biopsy to confirm the cancer’s presence. According to the National Cancer Institute, research has found that men with prostate cancer can have a low PSA level, while men without prostate cancer can have a high level. One in four men with an elevated PSA level actually has prostate cancer. However, an increase in PSA level over time may indicate a prostate tumor.

The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer, beginning at age 50. Men with one or more risk factors for prostate cancer should consult with their physician about whether to start routine screening earlier.
Symptoms of enlarged prostate can include:
A weak or slow urinary stream.
A feeling of incomplete bladder emptying.
Difficulty starting urination.
Frequent urination.
Urgency to urinate.
Getting up frequently at night to urinate.
A urinary stream that starts and stops.
Straining to urinate.

https://www.cancercenter.com/cancer-types/prostate-cancer/symptoms

(Image: Representation only)

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