I have written in the past about prostate cancer and about the use of a noninvasive technology called 3D color Doppler ultrasound for the diagnosis of prostate cancer and for the monitoring of the prostate. This month I wish to explain why I believe that this special ultrasound should replace the PSA test and the digital examination.
A number of my patients who had been diagnosed with prostate cancer, after having biopsies of their prostates, decided not to have traditional treatment. They all had cancers which ranged from stage II to IV, and their physicians believed that their cancers had not breached the capsule (at least until the biopsy punctured it!). In the course of researching for a non-invasive method for tracking their cancers (in order to see if the alternative methods they wished to use were working) these patients came to realize that the PSA test was not a particularly accurate test.
They became aware of the use of the 3D color Doppler ultrasound, and they ended up in the office of Dr. Robert Bard. Because I had a number of patients who were seeing Dr. Bard, I thought it would be advantageous to meet him. As it had been about 18 months since my last prostate exam, I decided to make an appointment at which I could personally experience Dr. Bard’s test. My previous digital exam had been reported as normal, with slight enlargement, and my PSA was normal with a value of 2.2. I had no symptoms.
In April of 2008 I went with my son, Adam, to meet Dr. Bard and was tested. Dr. Bard did a digital exam which was normal and then proceeded to do the transrectal ultrasound test.The results of the test were quite unexpected. Dr. Bard’s findings indicated the presence of a cancer, which he felt was advanced and in need of immediate attention.
The area of the cancer could not have been picked up digitally because of its position.What he found to be alarming was a bulging of the capsule with partial erosion of the capsule. He recommended that I have an MRI, and I did so that afternoon. The MRI confirmed the ultrasound’s findings and detected a suspicious lymph node in and around the outside of the prostate, known to be an area of metastasis from prostate cancer.
I went back to Dr. Bard a few days later to discuss all the findings with him and to have him do an additional ultrasound of my entire abdominal area to see if there was anything else that looked suspicious. Nothing else was abnormal. Because of the capsular erosion, Dr. Bard was worried about the lymph node that showed up as suspicious on the MRI. He said there was one place in Holland that could do a special MRI that would effectively diagnose whether or not the node was cancerous. Traditional treatment would be the removal of the prostate. Dr. Bard, however, recommended a certain type of electrical treatment to kill the cancerous area of the prostate. Unfortunately this treatment was not available in this country.
I had a PSA test, just because I was curious to see what it would show. The PSA value was 1.8, lower than it was previously!
I called a friend of mine, the late Shari Lieberman, to ask her advice, because I knew she was doing research on prostate cancer. She encouraged me to go to the clinic in Germany where she was doing her research. She called the head of the clinic and told them to get me in as soon as possible. I contacted them and forwarded all my information. In the meantime, Dr. Bard contacted the physician in Holland, and my wife and I looked into travel arrangements for that special MRI. If indeed the cancer had spread beyond the capsule, we were then into a whole different type of treatment.
All of this happened over the course of a few days. As the initial shock wore off, I said to myself, “Wait a minute, let’s slow down. Let me think this through.” Next month I will tell you what I did and how it all turned out.