A New Approach to Prostate Cancer
It is time. We need to rationally approach prostate cancer with new tools. Imaging first — biopsy last.
Men are in constant fear of an elevated PSA and its implications. It’s like watching the Dow. But the approach has been too slow to evolve.
Let me give you the best example. Women typically have an annual mammogram — often followed by an ultrasound (it should be the opposite). If you are diagnosed with a suspicious mass, a wire-guided biopsy is performed. This is very targeted and limited only to the specific area of interest. A positive biopsy is now most commonly followed by a lumpectomy. The story then becomes complicated.
For men, the approach is backwards, and medieval. A suspicious digital rectal exam, followed by an elevated PSA (greater than 4.0) will inevitably demand a prostate biopsy. 15 years ago this would have been a “4 core” sample. 4 blind stabs. But over the interval there has been a tendency to increase to 8 cores, then 12 cores and now 16 cores. Blind stabs through an area that cannot be sterilized. This can frequently cause infection, bleeding and pain.
It is time for this approach to come to an ignominious end. …