Articles tagged with: MRI

14
September
2013

Urology Cancer Surgery - Present and Future

Urology Cancer Surgery - Present and Future

Continuing the series of Guest Posts by highly regarded Urologists, Benjamin Davies from UPMC answers questions on Urologic Cancer Surgery

Dr. Benjamin Davies is a Urological Surgeon specialising in cancer management. He is an Assistant Professor in Urology at the University of Pittsburgh Medical Centre and the Director of the Urologic Oncology Fellowship. He is a respected clinician scientist and is considered a pioneer for urologists in social media, particularly Twitter.

In this post, Ben Davies answers questions on the current practice and future development of urological cancer surgery


Ben, what was your motivation to concentrate on urology cancers?

I think I was frankly attracted to tumour biology first and then I was introduced to the actual surgery. Once I started being a surgeon I quickly forgot about the basic science biology and become engrossed in large cancer surgeries and robotically enhanced ones as well. I like the direct impactful role that surgery offers to the patient right then and there. No waiting for medication to work or waiting for lab work….it’s operate and hopefully cure. Concrete work.


What is the hardest part of your job?

Sick patients are the absolutely most challenging. It’s simply not a 9-5 job. When I have a patient that is struggling I tend to really take it personally (which of course you shouldn’t) and you can easily become very stressed. Learning to manage the stress is part of becoming a successful physician but is definitely the most challenging.


Female urological system

What have been the biggest developments in urologic cancer in the past few years?

I think two things are the biggest developments:

1. Robotic surgery has significantly aided our surgical approach to prostate cancer care. It has without a doubt decreased the side effect profile of a rather morbid procedure.

2. Genomic testing is finally coming online. We have all been waiting for real genomic testing to help us with our care and the new prostate cancer tests (while still at the beginning of their testing) are promising.



What is the most important preventative measure in urological cancer?

Do not smoke. It is an absolute tragedy to smoke. Just stop it.


Ten years ago, an old boss of mine said to me …”Brook, in years to come you will look back on a holocaust of radical prostatectomies.” Is there is any truth in this?

Of course he was right!! We have done a major disservice in over-treating prostate cancer patients. And as a result our large US screening studies are flawed and we now have to deal with the consequences of bad data. The PSA screening debate has turned against us because we over-treated low volume, low risk prostate cancer without any pause and many times just for money. Hopefully the new generation of urologists has been sufficiently educated to stop the nonsense.


In ten years time, what will prostate cancer treatment look like?

Easy. After your MRI-guided biopsy you will get a genomic profile and risk stratification of your disease. If you are healthy man, then you will be offered a robotic prostatectomy at a centre of excellence.


Male urological system

Prostate cancer receives a huge amount of publicity and funding. Which urology cancer gets a rough deal, and what can be done to improve this?

The absolute worst is bladder cancer! The patient population that is affected is older, sicker, and has lower socioeconomic means. What to do?? The Bladder Cancer Advocacy Network is beginning to generate better lobbying efforts and academics certainly need to bring this issue to the fore more often.


You can read more about Ben Davies on the UPMC site, and follow him at @daviesbj on Twitter


Categories: Updates

07
August
2013

mpMRI in the Diagnosis of Prostate Cancer

mpMRI in the Diagnosis of Prostate Cancer

The diagnosis of prostate cancer is plagued by two issues. The first is the potential to ‘overdiagnose’ cancer, which means that small, low-grade cancers that may never cause problems are detected, and then potentially treated (also know as ‘overtreatment’). The second problem is that some more aggressive cancers may be missed with investigation. Unfortunately, these two problems are part and parcel of all tests in medicine.

The standard approach to diagnosis of prostate cancer has consisted of a PSA blood test and, if necessary, a prostate TRUS biopsy. These tests, when combined, can be effective but do lead to an element of ‘overdiagnosis’ & ‘overtreatment’ and occasionally more aggressive cancers can be missed.

There has been a lot of interest recently in the use of MRI to help with the diagnosis of prostate cancer. The hope has been that by using MRI (known as multiparametric MRI, or mpMRI) along with PSA tests (and possibly biopsy), the chance of overdiagnosis, or of missing aggressive cancers, can be reduced.

It is believed that the characteristics of aggressive prostate tumours may be unique on multiparametric MRI. By identifying the presence or absence of these MRI characteristics, biopsy may be targeted more accurately, or even avoided.

As well as identifying aggressive tumours, MRI may be useful for:

  1. Finding the location of tumours, and measuring tumour volume
  2. Staging of prostate cancer
  3. Helping to guide biopsy to increase accuracy

It is important to recognise that mpMRI is not perfect, and there is a good deal of debate about its exact role in the diagnosis of prostate cancer. It is certainly clear that it should be performed in experienced centres, and that the reporting needs to be standardised.

If you would like more information on mpMRI, please contact Nick Brook using the Web-form , or contact the Practice on 08 8267 1424.

As part of the work-up for your MRI, you will fill out a questionnaire in the radiology department. If any of the items below apply to you, please let the radiology department (eg. Bensons, Jones & Partners, Radiology SA, etc) know at the time of booking your MRI scan.

Tell the radiologist if you have ever had any of the following:

Pacemaker

Pacing wires/defibrillator

Artificial heart valve

Brain aneurysm clip

Cochlear implant

Ear implant

Neurostimulator

IVC (caval) filter

Intravascular coils (previous embolisation), filters, stents

Vascular clips or wires

Brain shunt

Metal pins, plates, rods, screws, prosthesis

Eye prosthesis

Implanted pain relief pump

Current intra-uterine device

Any other form of implant

A history of reaction to MRI contrast

A history of kidney disease

The radiologist also needs to know if you have any of the following

Hearing aid

Skin patches (nicotine or pain relief)

A tattoo (including tattooed makeup)

Shrapnel or bullet wound

Dentures or braces

Any type of body piercing

Tell the Radiologist if you have you ever had:

Heart surgery

Brain surgery

Ear surgery

Metal in your eyes

This list is not exhaustive, and is simply an indication of the questions you will be asked prior to your MRI. It is your responsibility to let the radiology company performing your MRI know about any of these issues.


Categories: Prostate Cancer

Affiliations

Urology Affiliations

Latest Tweets

Contact Us

  • Nick Brook Urology
    Calvary North Adelaide Hospital
    89 Strangways Tce,
    North Adelaide,
    Adelaide SA 5006
  • 08 8267 1424
  • 08 8267 1370