How Has Prostate Cancer Biopsy Advanced with Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • GPS Guided Biopsies offer greater accuracy in detecting and determining the type of prostate cancer, as they can pinpoint the growth more precisely than a regular biopsy.
  • High-quality T3 MRIs, molecular biopsies, and patient follow-up allow urologists to monitor the cancer closely and make better-informed decisions about the need for aggressive treatment.
  • Urologists use tools like rectal exams and prostate-specific androgen (PSA) tests to monitor the progression of prostate cancer and recommend surgery or radiation therapy if the cancer becomes aggressive.

Prostate cancer is one of the most common forms of cancer found in men. The likelihood of it forming in the walnut-shaped prostate organ increases with age. Luckily, there have been many major advances in how prostate cancer is diagnosed and treated. When it comes to diagnosing, board-certified urologist Dr. Jonathan Jay says, “First we must define where it is, how much of it exists within your prostate, and then what its behavior is like.”

Answering the where, how, and what is key to determining the type of prostate cancer and how to watch or treat it. Urologists are using advanced technologies to answer these questions. Urologists want to know how aggressive a cancer is when determining how aggressively they need to treat it. They can use a molecular biopsy and a high-quality T3 MRI to pick up on aggressive cancers. If an aggressive cancer is found, urologists can perform a more focused biopsy.

Dr. Jonathan Jay - Naples, FLThis focused biopsy is called a GPS Guided Biopsy and it has some very important advantages over a regular biopsy. The cancer may exist in a very small portion of the prostate, especially early on. This small cancer can be missed during a biopsy just by a sampling error, leading to a diagnosis that may not give a completely accurate picture of the cancer. But with a high-quality MRI, a guided biopsy can pinpoint the growth and the urologist can detect and determine the type of cancer with greater accuracy.

When the cancer is detected with greater accuracy, the urologist can now follow it more closely and understand what type the doctor and patient are dealing with. The urologist can perform a biopsy on the cancer to look at and understand its genetics. If the genetics show that it is not very aggressive or growing, then the urologist may decide to watch the cancer, as treatment may not be necessary. MRI’s and patient follow up can be used to watch the growth to see if there are any changes that may require more aggressive treatment.

Along with MRI’s, the cancer can be monitored with rectal exams and prostate-specific androgens (PSA) tests. These tools offer insight into the patient’s specific prostate cancer and its progression. If it becomes aggressive, the urologist can recommend surgery or radiation therapy.

A diagnosis is the beginning of a patient’s cancer treatment. At the Advance Urology Institute, urologists like Dr. Jonathan Jay utilize recent advancements in prostate cancer biopsies to provide their patients with the most accurate diagnosis and best treatment options.

TRANSCRIPTION: 

I’m Jonathan Jay, I’m a board certified urologist with Advanced Urology Institute.

One thing I’ve always said about prostate cancer, one you’ve got to be able to define where it is, how much of it exists within your prostate and then what its behavior is like.

So if we take that molecular biology and now we have MRI, T3 weighted MRI that can pick up aggressive prostate cancers and we do what we call GPS guided biopsy, a Euronav biopsy. So for instance, if I were sitting in this room and I’m the cancer, so this room is the prostate and I’m the cancer in the prostate, I could pass a needle through this room 15 times and miss me or just catch my baby toe. So I can miss the cancer just by sampling error. But if I had an MRI that said in this part of the room where I sit is an abnormality and it looks different than the other parts of the prostate and I focus on that, my ability to define and detect that cancer within that room is much higher. So we have the ability to do that. So not only did I detect the cancer in a much better way, but I have the ability now to follow the cancer. So if I biopsy that, look at the genetics of that cancer and it’s not very virulent, I can watch that cancer.

I got MRI which I can use to plot whether it changes in size or character. I can use the molecular biology to tell how fast it multiplies if it’s a virulent cancer. I’ve got PSA and I’ve got my rectal exam. So I’ve got three or four clinical tools for which I can follow that patient. We always talk about risk and benefit of treating any disease and we can watch this disease. If it shows that it’s being virulent or changing its character, then we can take the risk of having surgery or radiation. But we would not take that risk if it’s unnecessary if we saw something that was not changing much over time and a threat to the patient.

REFERENCES: 

Erectile Dysfunction Overview

Erectile dysfunction (male impotence) is a man’s inability to achieve or maintain an erection with enough firmness to have satisfying sex. Occasional erectile dysfunction (ED) is common and many men experience it when undergoing some form of stress. But frequent ED can be a sign of serious health, emotional or relationship problems that require the attention of a professional.

How common is erectile dysfunction?

Roughly 30 million men in the United States have problems achieving or maintaining an erection. The frequency of ED increases with age, affecting only 5-40% of men in their 40’s and up to 50-80% of men over 70 years. However, while the risk of ED increases with age, the condition is not an inevitable consequence of aging. Good health is the key to a lifetime of good sexual function.

Who is at risk of erectile dysfunction?

Dr. James Renehan of Tallahassee, FLApart from occurring frequently among the elderly, ED is often a consequence of poor emotional and physical health. It is common in men with high cholesterol, diabetes, obesity, cardiovascular disease, hypertension, prostate disease, anxiety, damage from surgery or cancer, injuries, stress, depression, performance anxiety, relationship problems, alcohol use, smoking, and drug use. Typically, ED is caused by vascular disease (such as atherosclerosis) that prevents blood supply to the penis, a neurological disorder (like multiple sclerosis) that cuts transmission of nerve impulses to the penis, chronic medical disorders such as Peyronie’s disease, stroke and diabetes, trauma, and operations for bladder, colon and prostate cancer which may affect blood supply to the penis. These risk factors may work singly or in combination.

How is erectile dysfunction treated?

When you visit a urologist, the first step in the diagnosis of the problem is a thorough sexual, medical and psychosocial history. Physical examination with emphasis on the genitourinary, neurologic and vascular systems is performed. From the information gathered, the urologist may request hormone tests (testosterone, luteinizing hormone, and thyroid – stimulating hormone, prolactin and serum hormone-binding globulin), urinalysis, PSA (prostate-specific antigen), lipid profile, and serum chemistry. Functional tests such as prostaglandin E1 injection, formal neurologic testing, nocturnal penile tumescence testing and biothesiometry may be requested, together with imaging studies such as transrectal, testes and penile ultrasonography and angiography.

If erectile dysfunction is diagnosed, the doctor may recommend treatment depending on the cause and severity of the condition. For instance, the urologist may recommend sexual counseling when no organic causes can be established for the problem. Oral medications such as sildenafil, vardenafil, tadalafil or avanafil may be offered to relieve the problem. But for those not responding to oral medicines, the urologist may inject, implant or direct the topical application of drugs such as alprostadil, phentolamine or papaverine. In some cases, an external vacuum or constriction device may be recommended while for other patients hormone replacement therapy may be used to treat severe hypogonadism (lower-than-normal testosterone). Alternatively, the urologist may opt for surgery through procedures such as revascularization, placement of penile implant or surgical correction of venous outflow.

How is erectile dysfunction prevented?

  • Eat a healthy, balanced diet that avoids saturated fats and increases the intake of vegetables, fruits and whole grains.
  • Reduce cholesterol levels through exercise, medication and diet.
  • Maintain a healthy body weight.
  • Exercise regularly.
  • Seek prompt treatment or professional help for conditions such as stress, depression, hypertension, heart disease and diabetes.

At Advanced Urology Institute, we recognize that effective treatment of erectile dysfunction involves a proper determination of the underlying cause and a frank discussion of both medical and non-medical options. This is why we have assembled an accomplished team of physicians, state-of-the-art facilities and a patient-centered system that responds to the unique needs of each patient. If you are experiencing a urological problem, make an appointment today. For more information, visit the Advanced Urology Institute website.