Prostate Cancer

Prostate Cancer & Benign Prostate Conditions - Diagnosis & Treatment at Sarasota Interventional Radiology

Prostate cancer is second only to skin cancer as the most common cancer among men in the U.S.  American Cancer Society statistics show that each year nearly 175,000 new cases of prostate cancer are diagnosed and over 31,000 deaths from prostate cancer occur. The more common prostate problem for men is a noncancerous condition known as BPH, or benign prostatic hyperplasia (BPH). SIR offers an effective option for the treatment of BPH and, when prostate cancer is suspected, SIR plays a significant role in its diagnosis and treatment.

The newest method in prostate cancer diagnosis is a specific type of MRI called multi-parametric magnetic resonance imaging (mpMRI). With this system, physicians first perform an MRI to determine if a prostate tumor actually exists. If the MRI indicates a need, several samples are taken of the specific site for biopsy, eliminating the need for multiple, painful biopsies.

"The best care I have received pre and post op. Wendy and Valorie are shining examples. I know what I'm talking about, I have 5 nurses in my family. Kudos to them. I had a fight on my hands, my employer is self-insured and would not help with the procedure that was best for me. Valerie and Wendy made my fight with prostate cancer a dream and renewed my faith in people. Thank you."

Paul M.

Treating BPH with Prostate Artery Embolization (PAE) – Treatment without Sexual Side Effects

Affecting about 60% of men over age 60, an enlarged prostate causes inconvenient symptoms including weak urine flow, dribbling and the frequent or urgent need to urinate. This condition is known as benign prostatic hyperplasia (BPH), and men who have it generally see a urologist for relief and discussion about the best course of treatment.

Traditional treatment options for BPH have included medications and surgery. Medications for BPH,which are not effective for some men and have many known side effects, fall into two main categories: alpha blockers and 5-alpha-reductase inhibitors.
  • Alpha blockers (alfuzosin, doxazosin, prazosin, silodosin, tamsulosin, terazosin) may have side effects which include dizziness, especially upon standing up, drowsiness and headaches.
  • 5-alpha-reductase inhibitors (finasteride, dutasteride) are associated with an increased risk of developing certain forms of rare, but serious, prostate cancer and sexual dysfunction, and emotional issues that include depression, anxiety and the potential for self-harm.
The surgical option, known as Transurethral Resection of the Prostate (TURP), is performed by urologists. With TURP, an instrument called a resectoscope is inserted through the tip of the penis and into the urethra to remove excessive growth areas of the prostate that affect urinary flow. TURP is considered by many medical professionals to be a rather barbaric procedure, and some patients may have a personal desire not to have this surgery or may have other medical conditions that rule out traditional surgery.

A third treatment option, Prostate Artery Embolization (PAE), works significantly better than medications for BPH, and has emerged from the medical arena of interventional radiology. For many years, interventional radiologists have used embolization techniques in other parts of the body, e. g., uterine fibroid embolization for women. They are able to use this experience, along with their considerable knowledge and skills, to successfully perform PAE for men.

At SIR, Florida’s premier radiology practice located in Sarasota, interventional radiologist Dr. Gerald E. Grubbs performs PAE to treat enlarged prostate without the risk of sexual side effects. Dr. Grubbs has worked with leading urologists for many years to provide treatment alternatives for both BPH and prostate cancer. This interdisciplinary, collaborative approach focuses on the welfare of the patient and helps to determine which treatment best fits each individual patient.

PAE is a minimally invasive procedure approved by the FDA, during which a catheter is inserted into the groin and, with imaging guidance, is directed to the prostatic arteries where microscopic particles are carefully injected. The skills of the interventional radiologist are paramount to ensure that the injected particles stay only in the prostatic arteries.

The tiny particles remain in the prostatic arteries permanently, blocking blood supply to areas of the prostate affected by BPH. The result is a reduction in the size of the prostate by about 30-40%, thereby alleviating some of pressure on the urethra and no longer obstructing the flow of urine from the urethra. This process is called embolization. Relief is generally noticed within one to two months, and more significant relief is felt within three to six months. Up to 80% of men who undergo the PAE treatment experience improvement.

To help keep the patient relaxed and comfortable, Dr. Grubbs performs PAE with conscious sedation administered by SIR’s board-certified anesthesiologists. The procedure generally lasts one to four hours, depending on the size of the prostatic arteries, followed by several hours in recovery. Driving is prohibited for 24 hours after the procedure, so a driver is needed to take the patient 内蒙古快3.

Prostate Cancer Diagnosis & Treatment at Sarasota Interventional Radiology

Always a leader in the use of new technology and methods to diagnose and treat disease, SIR is a strong advocate of the multi-parametric magnetic resonance imaging (mpMRI) for the detection of prostate cancer. The mpMRI replaces the traditional transrectal ultrasound-guided (TRUS) biopsy, a very uncomfortable procedure that takes random multiple core samples from all areas of the prostate. Even with the large number of samples, the actual site of a tumor may be missed, and the TRUS does not distinguish between tumors that need aggressive treatment and those that need to be watched.

Because of the new technologies that significantly reduce the inefficiencies of the transrectal ultrasound (TRUS) biopsy, patients with elevated prostate-specific antigens (PSAs) should be very proactive in the diagnosis of possible prostate cancer:

  •     Insist on having a state-of-the-art, pain-free mpMRI before having a biopsy.
  •     If the MRI indicates the need for a biopsy, insist on having a targeted MR/US fusion biopsy.
Diagnostic Prostate MRI (mpMRI)

Multi-parametric magnetic resonance imaging (mpMRI) is new technology in MR imaging that has opened the doors for detection of prostate cancer. Sophisticated equipment designed to take detailed images of the prostate is now being utilized to identify specific areas of interest for targeted biopsy.

DynaTRIM® is a fully MRI-compatible device for transrectal interventional MRI (TRIM) imaging of the prostate gland. It is a removable device that attaches to the top of an MR imaging table and enables physicians to conduct targeted MRI interventions of suspicious areas within the prostate gland. DynaTRIM® features an open design that allows for flexibility in choice of imaging coils, and offers a cleanable foam pad for extra patient comfort.

Why DynaTRIM®?
  • Produces very clear images
  • Distinguishes between benign and malignant areas
  • Reduces the number of cores that would be taken if a biopsy becomes necessary
After the MRI, DynaCAD® for Prostate allows the interventional radiologist to perform real-time, comprehensive analyses of prostate MRI studies. The powerful, easy-to-navigate digital imaging system quickly processes and manages the numerous prostate images. This technology easily synchronizes patient studies for further review and then generates complete, extensive summary reports that highlight all crucial aspects of the study.

Using the combination of DynaTRIM® and DynaCAD® for Prostate, patients can have peace of mind if the MRI rules out prostate cancer.
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice
DynaTRIM and DynaCAD—complete clinical MR solution for the prostate
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice
UroNav Biopsy System
MRI/Ultrasound Fusion Prostate Biopsy
UroNav® Biopsy System

The newest standard in the diagnosis of prostate cancer is the targeted MR/US biopsy, which fuses the pre-biopsy MR images with US-guided biopsy images in real time. SIR is one of the first outpatient facilities in the U.S. to install the UroNav® system for prostate biopsy, an MR-guided 3D fusion biopsy platform performed in the office using IV conscious sedation. This remarkable MR/US fusion technique produces excellent definition of the prostate and shows the exact location, shape, and size of the suspicious lesion.

Before the MR/US fusion biopsy, the patient must have an mpMRI of the prostate. Dr. Grubbs then reads the MRI images and produces a roadmap to pinpoint the suspicious lesion. During the MR/US fusion biopsy, the urologist uses the roadmap to guide the ultrasound probe through the perineum (the area of skin between the rectum and the scrotum) to the targeted lesion, thus fusing MRI with ultrasound in real time.

This new transperineal approach replaces the transrectal approach which reaches the prostate through the rectal wall. Although the traditional transrectal biopsy is still considered to be highly effective, the transperineal method has several advantages: lower risk of infection by avoiding the area close to the rectum, less chance of bleeding due to fewer blood vessels in the perineum, and higher rate of detection of a tumor located in the front and lower areas of the prostate. The transperineal fusion biopsy is the latest innovative type of biopsy that is performed to confirm or negate prostate cancer when a suspicious lesion has been discovered.

Working closely with Dr. Grubbs at SIR, top local urologists are currently using this latest and safest technique for prostate biopsy. With the UroNav® system, they have had great success in identifying and staging prostate cancer.
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice
MRI/US Fusion
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice
UroNav simultaneously displays registered MR and US images and the projected needle path relative to the suspicious target lesion
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice
Post-biopsy review provides the visualization and recording of target and biopsy core locations in multiple 2D and 3D views

HIFU - Revolutionary Prostate Cancer Treatment

If a diagnosis of prostate cancer is confirmed, the patient and his physician will want to discuss the available treatment options. Most current treatments have comparable results for non-return of the cancer, with those success rates ranging from 80-83%. However, erectile function and incontinence are factors the patient may want to take into consideration when deciding which treatment to select. The latest advancement in treatment for prostate cancer is a minimally invasive technique called High Intensity Focused Ultrasound (HIFU), a groundbreaking therapy that represents a paradigm shift in the treatment of prostate cancer. HIFU uses the fused MR/ultrasound images to create a customized plan to deliver high-intensity ultrasound energy to the prostate. In this procedure, HIFU sends focused ultrasound waves that increase the temperature of the targeted tissue within seconds, resulting in destruction of the diseased tissue. HIFU has significant advantages over traditional treatment methods:
  • Does not involve radiation or surgery
  • Targets and destroys diseased tissue but does not harm surrounding healthy tissue
  • Has significantly better outcomes for maintaining erectile function and eliminating the potential for urinary leakage; specifically, the risk of impotence and incontinence is only 2-4%, versus 40-60% with traditional surgery or radiation therapy.
HIFU may be focal, meaning that treatment involves only the cancerous part of the prostate, or it may be full gland, meaning that the prostate is treated in overlapping zones until the entire gland is completely ablated. Dr. Grubbs works with local urologists in the tri-county areas of Sarasota, Manatee and Charlotte counties in Florida to provide this treatment for prostate cancer patients.
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