Updates in the Management of CRPC - Episode 4
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There have been several changes to the methods used to diagnose prostate cancer in the past two decades, moderator Raoul S. Concepcion, MD, says. In the 90’s, digital rectal exam (DRE) generally led straight to a biopsy, since PSA was not an option. Now, in addition to DRE and PSA, transrectal ultrasounds (TRUS) are utilized to guide biopsy and calculate PSA density.
Outside of these approaches, the use of multiparametric MRI for prostate cancer diagnosis has gained support in recent years. In general, David Albala, MD, states that MRIs are 75% to 80% sensitive at detecting prostate cancer. Additionally, MRI effectively picks up extra prostatic extensions and seminal vesicle involvement. Diagnosis in prostate cancer is beginning to lean toward a multimodal approach. However, the costs associated with these new imaging techniques can be significant, Albala notes.
As this approach gains acceptance, a great deal of work will need to be done to fine tune techniques, states Stephen J. Freedland, MD. This initial legwork should be considered before adopting the approach.
One of the challenges facing the widespread use of MRI is the lack of standardization, Albala believes. Using current methods, a clearly defined standard for low-, intermediate, and high-risk has been established for categorizing patients. However, these same standards do not exist for MRI and other imaging modalities.
In general, multiparametric MRI provides a useful tool for examining the prostate, although this approach may not be applicable for every patient, notes David I. Quinn, MD. Despite its clear usefulness, there is still work that needs to be done in order to make it a practical imaging technique, Concepcion states.