PROSTATE CANCER IMAGING 101 + ACTIVE SURVEILLANCE- with Jim Hunt (feat. Dr. R. Bard)

 

According to the American Cancer Society, prostate cancer is the second leading cause of cancer death in men in the United States. It is widely recorded that the PSA test may give false positive results, whereby the PSA level may show elevated readings, but no cancer is actually present. False positive PSA tests have shown that out of all biopsies from elevated PSA readings, only 25% of the patients are found to have actual prostate cancer.  

Transrectal Ultrasound or TRUS is a guided biopsy and is one of the most frequently used guidance modalities for diagnosing prostate cancer. Although the procedure is performed in a systematic way, it does not function as direct visualization of suspicious lesions. MRI is another widespread technique to detecting prostate cancer noninvasively and is being increasingly used to guide targeted prostate biopsies. Multiparametric, MRI with T2W diffusion, or DWI and Dynamic contrast enhanced or DCE sequences is now the established approach to prostate MRI. This technique allows for improved detection, characterization, and staging of focal prostate cancer. Several new approaches are available to directly visualizing prostate cancer; Doppler ultrasound using elastography is one that is currently under development. In order to improve prostate cancer biopsy, accuracy of ultrasound elastography or UE can reveal stiff lesions that are not visible on traditional TRUS. The main methods for the UE diagnosis of prostate cancer include transrectal, real-time tissue elastography, and Shearawave elastography. [Courtesy of Dr. R. Bard / AIUM -UltraCon- download presentation on Prostate Imaging 2024]

Part 1: INTERVIEW WITH JIM HUNT

(Prostate Cancer Survivor & "Get Checked Now! Advocate) 

Courtesy of . Dr. R. Bard / AIUM (UltraCon)

I felt it was better to do something sooner than later and not wait till it got too bad. After doing the six years of the active surveillance, when they told me that the cancer spots did grow a little and there possibly could have been a fourth one, that's when my wife and I decided to discuss it consider treatment. Now I caught it right away and it had not gotten too big. I was able to do only five doses of the proton therapy.

 Over the years I've had conversations about someone who passed away of prostate cancer. When I hear about dramatic endings like “It went to his brain or it went to his lungs” – naturally, my having this same cancer leads me to ask, "is this gonna happen to me?"

DOCTOR-PHOBIA AND OTHER RESISTANCE ISSUES
Overall, I have never been a “doctor person”.  I personally have had trust issues with so many of them in the past. I've gone through five urologists through this whole journey and they don't make you feel comfortable.  For me, they're not very informative. They're just telling you what to do and they don't offer options.  I often walk out of their office feeling petrified and I think it's because they want to do surgery on you. That's the only thing I can think of. They seem to want to scare you into doing what they want to do.  Admittedly, I couldn’t help but think that most of them are about business, pushing surgery right away. 

Many of those who have been afflicted with Prostate Cancer in my immediate circle (in my observation) were pretty negligent (letting their cancer go). They weren't regular with checkups and they didn't treat it right away.  It's typical to be afraid of the doctor – and from experience, 'doctor-phobia' is because of the fear of the outcome.  But the question you really want to ask yourself is "do you want to catch it now when it's treatable? Or do you want to wait till it's out of control?" 

Now, unlike surgeons, the kind of doctor I found that was on my side is one that offers a SECOND OPINION.  Going to see Dr. Bard, a radiologist (specializing in advanced ultrasound imaging), became my best bet.  Getting second opinion scans with 3D Ultrasound became part of my ACTIVE SURVEILLANCE and this was what I felt I needed to keep me from worrying.  

EPILOGUE:
Dr. Robert L. Bard on ACTIVE SURVEILLANCE
Prostate cancer is extraordinarily common as you grow older. So the question is 'how deadly is it?' But a lot of it is low grade cancer. The body fights it off and the body is strong. It counteracts it. 

ACTIVE SURVEILLANCE: We actually have the technologies now that shows what it is, where it is and how aggressive it is.  In Jim's case, active surveillance allowed us to see there was something abnormal, but it was low grade. So he had time to look around and see what he wanted to do and decide on which one was the best for him at this time in his lifespan.

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