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      Health Medicine for Senior Citizens

      Contrast-Enhanced Ultrasound Detects High-Grade
      Prostate Cancer Using Less Biopsies

      Older men in active surveillance for prostate
      cancer would benefit from
      using microbubble technique to watch progession

      Oct. 1, 2012 Anything that reduces the necessity
      of biopsies is usually welcomed by senior citizens, the most likely
      victims of cancer. New research concerning prostate cancer, a common
      cancer hitting older men, indicates the time has come for the use of
      contrast-enhanced ultrasound to better detect high-grade prostate cancer
      and monitor low-risk ones using less biopsies.

      Findings from the randomized, double-blind trial
      revealed the technique, which uses microbubbles to measure change in
      blood flow, found almost three times as many higher grade cancers using
      half as many needle biopsies compared to systematic biopsy methods.
      Researchers from

      Thomas Jefferson
      University and Hospitals
      report their phase III study online
      in the Journal of Urology.


      Archive Stories


      Prostate Cancer Survival Rates Improved After Introduction of PSA Screening

      Growing evidence that questions U.S. Preventative Services Task Force recommendation against PSA screening in all men
      – Aug. 23, 2012

      No PSA Testing May Triple Cases of Advanced Prostate Cancer, Spread

      Data very clear: not doing PSA will result in many men with far more advanced prostate cancer spread to other parts of the

      July 30, 2012 – Eliminating the PSA test to screen for prostate cancer would be taking a big step backwards and would
      likely result in rising numbers of men with metastatic cancer at the time of diagnosis, predicted a University of Rochester Medical Center
      analysis published in the journal, Cancer. Read more…

      Debate About Recommendation Against PSA Test for Prostate Cancer to Continue

      The recommendation by U.S. Preventive Services Task Force against PSA screening for men of any age for prostate cancer stirs
      swirl of controversy: says special report in NCI Cancer Bulletin

      By Carmen Phillips, National Cancer Institute – June 5, 2012

      More links to prostate cancer reports below story


      Read the latest news

      Health Medicine

      Today’s Headlines


      “Today, a physician may sample 12 to 18 tissue
      cores from the prostate in order to help diagnose a patient. But with
      contrast-enhanced, that number drops to six or even less,” says lead

      Ethan Halpern
      , M.D., co-director of the

      Prostate Diagnostic
      Thomas Jefferson University Hospital and professor of
      Radiology and Urology at Thomas Jefferson University.

      “So it’s less invasive, and a more effective
      guidance tool. We’ve found that with contrast-enhanced ultrasound, we
      are much more likely to detect cancers on the image, and in this case,
      the higher grades.”

      Results from the clinical trial of 311 men, 118 of
      which had positive prostate cancer biopsies, revealed that targeted
      biopsies using contrast-enhanced ultrasound with microbubbles detected
      significantly more higher volume/grade prostate cancers (clinically
      significant) in men (55%) compared to a conventional prostate biopsy
      technique (17%).

      Ultrasound imaging of the prostate is commonly used
      to assess the size of the gland and for needle placement during
      systematic biopsy, but is limited by difficulty in distinguishing benign
      from malignant tissue. What’s makes contrast-enhanced ultrasound
      different is the microbubble contrast agents, tiny bubbles of gas
      contained within a supporting shell that are injected into the patient
      to help better measure changes in blood flow.

      Prostate cancer, like many cancers, harbors
      abnormal blood vessel flow. This change in flow in the prostate can be
      measured by ultrasound; the microbubbles enhance the reflection of those
      ultrasound waves.

      The technique has been used with success in Europe
      for some time, but researchers at Jefferson say it’s ready for primetime
      in the United States. The U.S. Food and Drug Administration hasn’t
      approved it for use for prostate screening, although it is used in other
      imaging applications.

      In the clinical trial, researchers performed both
      targeted biopsies using contrast-enhanced ultrasound with flash
      replenishment maximum intensity projection MicroFlow Imaging on all
      patients, and a systematic 12-core biopsy protocol for comparison. The
      mean age of the patients was 62 years and a PSA level of 6.5ng/mL.

      “Our ultimate goal is to perform a limited number
      of targeted biopsies and leave the rest of the prostate alone,” says Dr.
      Halpern. “This will provide a safer, more cost-effective approach to
      diagnosing prostate cancer.”

      Subjects were also randomized to pretreatment with
      dutasteride, a drug used to treat an enlarged prostate, and placebo;
      however, no was significant difference in the proportion of positive
      biopsies for prostate cancer.

      Dr. Halpern, who is principal investigator on the
      four-year, National Cancer Institute-supported trial, has been
      developing and refining techniques to enhance targeted biopsy of the
      prostate for more than a decade, along with his colleagues at

      Jefferson, Edouard J.
      Trabulsi, M.D.
      , co-director of the Prostate Diagnostic Center
      and associate professor of urology,

      Flemming Forsberg,
      , a professor of Radiology,

      Barry Goldberg, M.D.
      , director of the Division of Diagnostic Ultrasound, and

      Leonard Gomella, M.D
      F.A.C.S., director for Clinical Affairs at the

      Kimmel Cancer Center
      at Jefferson
      , and Chair of the Department of Urology. Peter
      A. McCue, M.D., a professor in the Department of Pathology, Anatomy and
      Cell Biology at Jefferson, was also part of this study.

      Because prostate cancer often grows very slowly,
      some men, especially those who are older or have other serious health
      problems may never need treatment. Instead they may benefit from active
      surveillance where their cancers are carefully monitored with various
      tests to determine if the cancer is beginning to be more aggressive.

      “It stands to reason that the cost-benefit ratio
      for prostate cancer screening will improve if PSA screening is followed
      by a limited targeted biopsy based on contrast-enhanced ultrasound,”
      said Dr. Trabulsi. “This also means contrast-enhanced ultrasound can act
      as another monitoring tool for active surveillance in low-grade cancer
      patients, potentially preventing unwarranted treatments.”

      Links to More on Prostate Cancer in SeniorJournal.com

      Four New Drugs Will Change Prostate Cancer Care, Colorado Expert Says

      Hope this will lead to making prostate cancer a disease a patient is more likely to die with than from,
      By Garth Sundem, Feb. 16, 2012

      Researchers Find Possibility of Heart Disease Causing Prostate Cancer

      Duke researchers find evidence linking prostate cancer and coronary artery disease – Feb. 8, 2012

      Why Observing Prostate Cancer Gaining Ground On Surgery: NIH Panel Says Not Cancer

      Some think these tumors should be rebranded as something else, such as idle tumors

      By Richard Knox, NPRs Shots blog – Dec. 9, 2011

      Delay of Treatment for Low-Risk Prostate Cancer Gets Nod from NIH Panel

      Recommends active monitoring but details of strategies not determined, Dec. 8, 2011

      Cardiovascular Deaths Not Linked with ADT for Prostate Cancer but Lower All- Death Risk May Be

      Study should be ‘generally reassuring’ to most men with unfavorable-risk prostate cancer considering ADT, because it was
      associated with improved survival  – Dec. 7, 2011

      Prostate Cancer Patients Considering Suicide May Find Help in New Concept

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      Oct. 31, 2011

      Influential Panel Giving Thumbs Down To Routine PSA Test for Prostate Cancer

      See links to other comments and reports on this recommendation

      By Scott Hensley, NPR News,
      Oct. 10, 2011

      New Models Predict Likelihood of Erectile Function Return After
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      Problem still there but it helps men make better informed decisions with realistic expectations –
      watch video report

      Sept. 20, 2011

      New Surgery-Free Treatment for Enlarged Prostate
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      Prostatic artery embolization as effective as popular
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      Michigan researchers outline how to improve communication about the risk

      Sept. 20, 2011

      Concern Is Growing That the Elderly Get Too Many Medical Tests; Little Benefit

      Growing skepticism about widespread, routine screening for cancer and other ailments of people in their 70s, 80s and 90s

      By Sandra G. Boodman, Kaiser Health News

      Sept. 13, 2011

      Prostate Cancer Patients Live Much Longer with Hormone Therapy Added to Radiation

      graphs of prostate cancer cases and deaths 1987-2007 below story

      ADT therapy works well with intermediate grade cancer, not so well with low grade; only two grades tested in this trial

      July 15, 2011

      Medicare Bites Bullet to Cover Expensive Provenge,
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      also to continue expensive breast cancer drug, Avastin; Sipuleucel-T activates immune system to defend
      against prostate cancer; first approved autologus cellular immunotherapy

      July 1, 2011

      Cancer Death Rates Continue Decline That Began in
      Early 1930s Says Cancer Society

      Cancer Statistics 2011 shows among men the
      reduction in lung, prostate, and colorectal cancers is nearly 80% of
      decline; among women, almost 60% of decrease in breast and colorectal –
      see chances of seniors getting cancer –
      June 17, 2011

      Drug Approved to Treat Nail Fungus Found to Delay
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      Itraconzole slows prostate cancer progression but
      has potential of serious side effects –
      June 3, 2011

      Rising PSA
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      News study shows nearly 70 percent with rising PSA
      eventually get prostate cancer –
      May 18, 2011


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