04.06.2014

Prostate cancer treatment and management

The main purpose of the prostate is to produce fluid for semen, which transports sperm during the male orgasm. The apex is directed downward and is in contact with the superior fascia of the urogenital diaphragm. In almost all cancers, with the exception of prostate, when we do biopsies with the purpose of diagnosing cancer, we target the lesion. Up until recently, when someone met the criteria to have a biopsy of the prostate, the typical process involved performing an ultrasound study of the prostate and inspecting the prostate to see if we could spot anything to target. So the goal was to find a way to localize the lesions that we see on an MRI, but use something in an office environment that’s readily available, like ultrasound, to do the targeting.
Today when we get an MRI, the radiologists provide us a scale that’s rated 1 through 5, known as the PIRAD score.
So when we see patients with a PIRAD 1 or 2 lesion, the likelihood of finding cancer in that lesion is pretty low, less than 30 percent.
Q: In addition to the increased accuracy, what are some of the other benefits of 3D MRI fusion biopsy? Typically, our patients are very happy with the technology because we can show them on the screen what their prostate looks like and what appears suspicious. In addition, 3D MRI fusion biopsy allows us to decrease the number of overall biopsies since we can now better determine who, in fact, would truly benefit from a biopsy. We are finding a significant number of patients were under-staged at the time of their initial biopsy and that they’re in need of moving from active surveillance to a treatment pathway.
DR CURRAN: The biggest challenge we face with insurance companies is that they are making it harder for us to get MRIs.
Again, it’s because of our integrated group practice of urology that has allowed us to have these conversations with insurance companies and to provide this service to our patients.
The Gleason score is a number from 2-10 that the pathologist gives us that tells us how aggressive the cancer is. We’re finding that many patients who we tell have a Gleason 6 disease may actually have a Gleason 7.
So the ability to not only target that tumor, but also target the center of the tumor may have an impact on what we recommend to the patient for treatment. Q: If a reader is interested in going through Greater Boston Urology for a 3D MRI fusion biopsy, how would that work? If someone would like a consult, he is free to go to our website and contact one of our doctors. From a billing perspective, if you’re in a closed-network system, it depends on whether you have any out-of-network benefits or not. The 38 year-old says breast cancer had never crossed her mind when she discovered a lump in her left breast in 2009.
In January this year, Van Kramberg had to undergo surgery to have her whole left breast removed because the cancer cells were slowly beginning to spread to other parts of her body. If you pick it up as a lump early and you treat it and have it removed with whatever treatment is appropriate, you stop all the other things from coming on later”. Anderson encourages people to do self-examinations to check for any abnormalities in their breasts.
Jerry Okungu was born in Awasi, Kochogo Village in the then East Kano Location in Central Nyanza, Kenya.
A new paper published online in Nature holds out hope that people with the second most common type of lung cancer may one day benefit from targeted therapies that have transformed treatments for other lung cancer patients. Squamous cell lung cancer kills more people each year than breast, colorectal, or prostate cancer, ranking second only to lung adenocarcinoma in the number of deaths it causes. The first targeted treatments for lung adenocarcinoma, erlotinib (Tarceva) and gefitinib (Iressa), were aimed at mutations in the EGFR gene.
As in the three previous TCGA reports on the brain cancer glioblastoma, on ovarian cancer, and on colorectal cancer, the scientists used multiple large-scale approaches to highlight key molecular defects.
Overall the researchers identified mutations or amplifications in three families of tyrosine kinases, which are enzymes that act like power switches for many cellular functions.
In another striking finding, the researchers discovered mutations in the HLA-A gene that hampered its function in tumors.
Other researchers from the Broad, Dana-Farber, Harvard, and their affiliates who contributed to the paper include Michael S. Some people have the flare-up of the rash due to coming in contact with animal dander, detergents, soaps, perfumes and other chemicals. Olive oil is full of antioxidants which remove all the impurities and toxins from the blood, stimulate circulation and soothe the skin immensely. Apple cider vinegar has innumerable medicinal values which cure a vast number of diseases and ailments.
It is located in front of the rectum and just below the bladder, the organ that stores urine. The prostate gland’s location and the limits of the technology make it difficult to get a precise view, however.


CURRAN: In the last several years, we have seen increased interest in using MRI to evaluate the prostate. The biggest issue is that it’s very difficult to do a targeted biopsy on an MRI machine. With a PIRAD 4 or 5 lesion, the likelihood of finding cancer in that lesion rises up around 80-90 percent and in some cases, even higher. If we’re doing a 3D MRI fusion biopsy, we find cancer in over 80 percent of those patients. At Greater Boston Urology, we’ve adopted criteria to decide who should have a 3D MRI fusion biopsy. Patients who had prior negative biopsies (so the blinded ultrasound biopsy came back with no sign of cancer), but the patient’s PSA is still rising. Patients who’ve been diagnosed with low and very low risk prostate cancer who are in active surveillance protocols. CURRAN: MRIs are not one hundred percent perfect, which means we still find cancers in areas that look normal on MRI. At Greater Boston Urology, we have designated three specific physicians who have done additional training and have spent hundreds of hours gaining expertise in utilizing this technology.
I have heard countless stories from urologists having a hard time getting MRIs approved by insurance companies, which ends up being a roadblock to using the technology. When we explain to insurance companies that this is not a random request, we have the guidelines discussed above, and we’re using this technology in an effort to reduce the number of people having biopsies overall, then they typically will approve the MRI.
CURRAN: We were the first group in New England to perform 3D MRI fusion biopsy with a system called Artemis. CURRAN: Thanks to this technology, our understanding of prostate cancer has changed in two specific areas.
For patients who have been told they can go on active surveillance, we’re finding that some of them had cancers that were under-staged. What we’re finding, thanks to 3D fusion biopsy, is that as you get more central to the tumor itself, the Gleason score increases. The 3D MRI fusion biopsy gives us the ability to better target the center of the tumor, resulting in a more precise Gleason score. If you are a patient outside of GBU, we’re more than happy to work with your urologist to provide the technology and then return you to your doctor once the biopsy is done. Both men and women are urged to go for regular breast examinations so that abnormalities can be dealt with sooner and quicker. Much like Van Kramberg, Basson says practising a healthy lifestyle lessens your chances of developing breast cancer. The Chief Executive of Profmed Medical Scheme, Graham Anderson, says this is important, especially because breast cancer spreads rapidly.
It goes from the breast into the endocrine system, which spreads into the liver, the stomach, and the lungs and, sometimes, into the brain.
But unlike the most common form of lung cancer, squamous cell carcinoma has no treatments aimed at the specific genetic alterations that drive it.
The Cancer Genome Atlas (TCGA) Research Network, led in part by scientists at the Broad Institute, Dana-Farber Cancer Institute, and Harvard Medical School, has identified many potential therapeutic targets based on the large number and variety of DNA alterations they discovered in most of the tumors they studied. Unfortunately, and like other drugs being tested in clinical trials that target several other genes altered in lung adenocarcinoma, they do not help patients with squamous cell carcinoma.
They sequenced the protein-coding segments of the genomes of 178 squamous cell carcinoma tumors, along with normal tissue from the same patients. For example, the TP53 gene was altered in 90 percent of the tumors and the CDKN2A gene was inactivated in 72 percent of tumors. Frequently altered in cancer, they are already being investigated as therapeutic targets in other cancers. HLA genes direct the arm of the immune system that discriminates between its own tissues and foreign invaders. Lawrence, Douglas Voet, Rui Jing, Kristian Cibulskis, Andrey Sivachenko, Petar Stojanov, Aaron McKenna, Stacey Gabriel, Carrie Sougnez, Marcin Imielinski, Elena Helman, Bryan Hernandez, Nam H. Broad Institute of Harvard and MIT was launched in 2004 to empower this generation of creative scientists to transform medicine.
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We’ll see a targetable lesion by ultrasound probably less than 10 percent of the time.
We’ve also seen advances in MRI technology that give us clearer pictures of the prostate gland.
The equipment alone would need to be highly specialized since we’d be performing the biopsy while in a magnetic field.
Infection is a possibility, but our infection rate at Greater Boston Urology is less than 1%, which is better than national averages.
Their risk of harboring cancer is increasing based on the fact that they have a rising PSA. When we do a blind ultrasound biopsy of the prostate, we’re really hoping to find the cancer if it exists. We have been very fortunate to be in an integrated urology group that allows us to make sure all of our patients, regardless of which of our offices they go to, can have access to this type of technology and the expertise our doctors have gained in doing the biopsies. Historically, the anterior part of the prostate gland was very difficult to sample, and, thus, under-sampled when doing a blind ultrasound-guided biopsy. Bottom line: we can provide the technology to anybody who wants it, provided he fits the criteria. The TCGA effort, a multicenter consortium funded by the National Institutes of Health, is the first comprehensive genomic characterization of this lung cancer subtype. These genes normally prevent cancer, but when they are switched off, tumors can grow unimpeded.
The researchers also found genomic alterations in signaling pathways that could present important opportunities for treatment. This is the first cancer in which these mutations have been found, but they are likely to occur in other cancers, Meyerson said.
It is mostly hereditary but allergies, a very dry skin, bacterial and fungus infections can also cause it. Though this condition is not a threat to health, it is extremely uncomfortable and unsightly to be scratching like crazy all the time. It has wonderful anti-inflammatory, antibacterial and antioxidant properties.These properties soothe the irritated skin, reduce the burning and itching and keep the skin well moisturized. If you have liver cancer, we’ll get a CAT scan or MRI and target the lesion and biopsy that. And when we target that, it still might be 50-50 whether we find cancer in that lesion or not. As such, we’ve created criteria that the radiologist can use to find specific lesions in the prostate that we should be targeting for biopsy. As the PIRAD score increases, the likelihood that you’ll find cancer in that lesion will increase. Some of these patients might have cancer that the first biopsy missed, and some patients do not have cancer. After consultation with a doctor, van Kramberg was advised to go for a mammogram and ultrasound. Perhaps the only thing which counted against me was that I got my baby too late – after 30. They mapped a diverse catalog of genomic alterations, including the rearrangements of chromosomes and other structural changes in regions of the genome that might not encode proteins but could control nearby genes involved in cancer development. CDKN2A may be susceptible to a kinase inhibitor, presenting an opportunity for clinical trials. However, simple home remedies will not only bring relief in the symptoms but will also help to cure it, over a period of time.
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News & World Report, and one of the largest recipients among independent hospitals of National Cancer Institute and National Institutes of Health grant funding.
So if we don’t see a lesion on the MRI, we may decide not to repeat the biopsy in that patient.
So it’s changing our understanding of where cancer is in the prostate gland, which is a significant benefit.
We may just follow their PSA or follow them by MRI, or follow them by a combination of PSA and MRI.
Onofrio, Andrew Crenshaw, Kristin Ardlie, Rameen Beroukhim, Wendy Winckler, Michael Noble, Nils Gehlenborg, Alexei Protopopov, Angela Hadjipanayis, Semin Lee, Ruibin Xi, Lixing Yang, Xiaojia Ren, Sachet Shukla, Peng-Chieh Chen, Psalm Haseley, Eunjung Lee, Raju Kucherlapati, Daniel DiCara, Jinhua Zhang, Hailei Zhang, Chang-Jiun Wu, Yingchun Liu, Lihua Zou, Pei Lin, Juok Cho, Marc-Danie Nazaire, Jim Robinson, Helga Thorvaldsdottir, Jill Mesirov, Peter J. It can be beaten with positive attitude, humour, support structure and faith”, says Basson.



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