women should alert themselves to the possibility of early breast cancer as they routinely undergo ultrasound breast screening twice a year. In practice, about 5% of men develop aggressive interval cancers within half a year from their last normal or stable evaluation. A presentation entitled “Interval Cancers of the Prostate: Evaluation By 3-T MRI and 3-D Power Doppler Ultrasound” was made at the 2009 meeting of the Societe Francaises de Radiologie in Paris demonstrating that new aggressive tumors may occur more rapidly than clinically expected and may, in part, explain the failure of certain treatments.
When a man has not had a biopsy or has had a negative biopsy and a vascular tumor is demonstrated on the 3-D PDS, an MRI exam is recommended, which shows the prostate gland, the capsule of the prostate, the regional lymph glands, seminal vesicles, and boney pelvis. Other bones, to which cancer frequently spreads, such as the lower spine and hip, may also be imaged for abnormalities. While the MRI exam is not as good an indicator of cancer aggression, it shows spread of the tumor outside the prostate capsule to the lymph nodes better then the 3-D PDS and better than the CT scan, which is currently used as the standard test for staging.
Assessing Response to Prostate Cancer Therapy
The value of medical imaging is to:
•Localize the volume of disease including extracapsular extension.
•Assess bone metastases, seminal vesicle invasion, and lymphadenopathy.
•Estimate degree of aggressivity (similar to Gleason grading).
•Determine efficacy of therapy.
•Monitor changes.
•Tailor future therapy.
•Determine tumor recurrence.
•Identify new tumors.
One of the problems of evaluating cancer treatment is that the tumor may be rendered harmless or even dead but the volume of the tumor remains the same or even enlarges. That is, the cancer cells may be killed off and scar tissue replaces the dead cells, leaving the size of the original malignancy unchanged, or edema and necrotic fluid buildup enlarge the region simulating tumor growth. This lesson was learned 19-years ago in treating liver tumors. The therapy would render the cancer harmless, but the size of the mass on the isotope scans, sonogram, CT, and MRI would remain unchanged or even enlarge. The same is true of some PCa’s that are inactivated but still feel like cancer on the digital rectal exam and show a mass effect on the sonogram and MRI. There needs to be a way to monitor changes and determine the efficacy of treatment. Fortunately, the blood flows in malignancies that have been inactivated decrease or disappear and can be quickly and accurately measured in the moment. Thus, with 3-D PDS there is a simple tool to quantify blood flow patterns to demonstrate therapeutic response.
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