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Physicians Update

 
Fall 2010

High-Tech Imaging Improves Surgical Outcomes for Prostate Cancer

12/01/2010

PU Fall 2010-High Tech ImagingState-of-the-art magnetic resonance imaging (MRI) technology at UCLA is driving key advances in the diagnosis and treatment of prostate cancer. MRI assists surgeons both prior to and during robotic-assisted prostatectomy and by potentially enabling more minimally invasive treatment.

“We’re using MRI in almost everything we do now,” says Robert Reiter, M.D., M.B.A., director of the UCLA Prostate Cancer Program. “It is having a number of positive effects.”

Among those positive effects is a move toward focal treatment of the prostate lesion rather than removal or irradiation of the entire prostate. For the last seven years, the program has honed a technique known as multiparametric MRI using the powerful 3-tesla magnet. The technology merges MRI with ultrasound images to obtain a three-dimensional view of where the cancer is located at the time of biopsy. “We measure different parameters to sensitively and specifically detect the cancer in the prostate,” Dr. Reiter explains. UCLA is the only center in Southern California that has made significant use of the technique, having employed it in more than 500 patients.

The UCLA Prostate Cancer Program performs transperineal template biopsy for men who appear to be candidates for surgery that would target the individual lesion while sparing most of the prostate. Rather than the usual ultrasound biopsy done in the office, patients are taken to the operating room for a biopsy that includes a mapping study seeking to corroborate findings from the MRI.

If it’s determined that the lesion is focal and not high risk, patients are being offered an experimental protocol using photodynamic therapy. The drug treatment includes the injection of fibers that emit laser energy, activating the drug to target and ablate the lesion. “This eliminates the risks associated with treatment of the entire prostate gland, including impotence, incontinence and rectal injury,” Dr. Reiter notes. He estimates that 10–20 percent of his patients would be candidates for focal therapy, including many who might otherwise choose surveillance rather than treatment because they want to avoid side effects. Photodynamic therapy enabled by the powerful imaging tools offers these patients a potential new option.

In addition, MRI is increasingly used at academic medical centers like UCLA to monitor patients who choose surveillance over treatment, says radiologist Daniel Margolis, M.D., co-director of the UCLA Prostate MRI Group. “Prostate MRI is not designed to replace current practices, at least not yet. However, it can be helpful for physicians in specific situations,” Dr. Margolis says.

PU Fall 2010-Prostate CancerThe UCLA Prostate Cancer Program also benefits from state-of-the-art MRI technology for surgical cases. MRI is used to image the prostate for all patients scheduled to undergo robotic prostatectomy, providing a surgical roadmap. In a study of 110 consecutive patients treated in this way, Dr. Reiter and colleagues found that the imaging resulted in changes to the surgical plan nearly one-third of the time.

“In some cases, when the initial information suggested that we needed to do a very radical operation, we were instead able to spare the nerve thanks to what we learned from the imaging,” Dr. Reiter explains. “Other times, when all indications were that the patient had a low-risk tumor, the MRI told us that the lesion was in fact more aggressive and we acted accordingly.” With MRI-guided robotic prostatectomy, the proportion of UCLA Prostate Cancer Program patients with positive surgical margins — cancer still present at the edge of the gland following the operation — is down to 7 percent, well below the national average, Dr. Reiter notes.

Robotic technology continues to assist surgeons in achieving results with minimally invasive prostatectomy that are comparable to open surgery when it comes to eliminating cancer and preserving potency and urinary continence, Dr. Reiter says.

Dr. Reiter also recently began performing a robotic simple prostatectomy for patients with benign prostatic hyperplasia who have particularly large prostates. Historically, these patients have required an open operation to remove the portion of the prostate causing blockage of urine flow.





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