Prostate Cancer Awareness Week (pcaw.org) has compiled information on the issue of. the use of a color doppler ultra sound to do a better job of detecting cancer concentrations in the prostate cancer to (1) prevent unnecessary biopsies and (2) if one is recommended, to get a better, more accurate reading of the extent and location of the cancer. Far superior to an ultra sound.
Duke Bahn On Color Doppler Ultrasound
Color Doppler Ultrasound a useful tool in PC staging and diagonosing
Meet Duke K. Bahn, M.D. Medical Director
Color Doppler Resource
Dr. Duke Bahn On Color Doppler Ultrasound
Many of you have heard Dr. Myers speak about Dr. Duke Bahn and the Color Doppler Ultrasound both on this blog and in the Prostate Forum newsletter. We recently had a chance to talk to him about Color Doppler Ultrasound, why it is different from other prostate cancer scans, and why it should be the first stop on a mans prostate cancer journey. If youd like to contact Dr. Bahn, you can do so here.
Dr. Bahn: The most common way of detecting prostate cancer is by having an ultrasound and an ultrasound-guided biopsy. A man is a candidate for an ultrasound evaluation: 1) when his PSA is high; 2) his PSA shows an elevating trend, even if its not that high; and 3) he has had a positive digital rectal examination (DRE). If he has had a positive DRE, regardless of his PSA, he is a candidate for ultrasound evaluation.
The problem were facing right now is that theres an arbitrary cut-off for the PSA at 4. Anybody who has a PSA over 4 gets a biopsy indiscriminately, perhaps causing clinically insignificant cancer to be detected. It results in over-detection and eventually over-treatment of prostate cancer.
The role of the Color Doppler Ultrasound is in examining the prostate by blood flow pattern (color) in addition to black and white images. In a Color-Doppler study, we pick up about 15-20% more cancers. The Color Doppler Ultrasound also helps us identify the exact tumor size. The tumor size seen on Color Doppler is usually larger than it is in black and white. So the black and white image underestimates the cancer size. In addition, if we see a suspected lesion in black and white and that suspicious lesion shows increased blood flow, it is most likely cancer. The more flow in the lesion, the higher the Gleason grade in general. Then we perform a targeted biopsy rather than a blind systemic random biopsy. A targeted biopsy has a higher yield with fewer tissue cores taken. By getting tissue from the middle of the action, we can get a more accurate Gleason grading. Also, based on the cancer location we can anticipate where the cancer would have spread out, if at all. We can take a tissue sample from the most probable area of cancer escape, like the neurovascular bundle, or nearby seminal vesicle. By doing so, we can determine the exact stage of the cancer. Knowing the correct Gleason grade and the exact stage of the cancer are important prior to making a final treatment decision.
Since Color Doppler Ultrasound can identify the cancer clearly by the location, size, and blood flow pattern, it can be objectively monitored over the years, especially if someone is undergoing active surveillance.
Is Color Doppler Ultrasound an important tool for active surveillance patients?
Color Doppler Ultrasound is very important not only in assessing the entire prostate cancer situation, but also in monitoring someone undergoing active surveillance. Without Color Doppler Ultrasound, youre primarily depending on the PSA, which is not perfect. PSA levels can go up and down and are influenced by many other factors. And the digital rectal examinations are so subjective. These are not really scientific ways of following the cancer. If we have a clearly identified index tumor on base line imaging studies, then we can objectively monitor the lesion over the years.
How often do you feel Color Doppler Ultrasound should be done for those in an active surveillance program?
For patients undergoing active surveillance management, I recommend a PSA test once every three months for two years. If there are two or three consecutive PSA risings, the patient should get a Color Doppler Ultrasound. Otherwise, an annual Color Doppler ultrasound would be acceptable. If all the findings remain stable for two years, then the patient can have a PSA test done once every 6 months and a Color Doppler Ultrasound every two years. We just finished collecting data on 520 men undergoing active surveillance up to 10 years. During that ten years time, we found that about 30% of men needed some treatment because ultrasound clearly showed disease progression. Increased blood flow in the known cancerous lesion was the first sign of the cancer progression. So 30% of men in this cohort ended up having proper loco-regional treatment. We did not have any patients who developed metastases or who died. No one got into trouble. The point here is that 70% of men are doing just fine up to ten years. This result is similar to other published data. Certainly, proper patient selection was the key to this favorable outcome.
Youre based in Ventura, CA, but you have patients come to see you from all over the world. Do men need to be referred by an oncologist or urologist or can they seek you out independently?
I see a variety of patients. The first group of patients includes men who have had a high PSA or a positive DRE and are told they need to see an urologist for an ultrasound and biopsy. Rather than going to the urologist as recommended by their physician, they come to me as a self-referral. They often hear about me form neighbors, friends, and co-workers.
Another group of patients includes men referred from doctorseither primary care physicians, urologists, or medical oncologists like Dr. Myers or Dr. Scholz. Patients referred from the medical oncologist are usually the easiest to handle. Medical oncologists have already educated the patient. They know what to expect and they know why they are here to see me.
But there is also a group of men who worry about their prostate
health due to certain high risk factors they may have. After
assiduous online search, they come to me to get a good baseline Color
Doppler Ultrasound for future reference.
Meet Duke K. Bahn, M.D. Medical Director
Lately, he brought a concept of Male Lumpectomy in the prostate cancer treatment and standardizes the focal cryoablation technique that is freezing the cancerous portion of the prostate only as an outpatient, minimally invasive procedure. His latest task of cryoimmunotherapy clinical trial has FDA approval and being studied.
Dr. Bahn has held many academic and professional appointments
including clinical professor of urology, Keck school of medicine,
University of Southern California. He has published many scientific
articles relating to the diagnosis and treatment of prostate cancer.
He has been elected as Americas Top Doctors and
Americas Top Cancer Doctors. He actively promotes
prostate cancer education and patient empowerment through his
extensive speaking appearances with both patient support groups and
medical communities throughout the world.
Color Doppler Resource
The Prostate Institute of America is located on the Community Memorial Hospital campus in Ventura, California, about 60 miles north of Los Angeles. Dr. Duke Bahn, The Prostate Institute of America, Community Memorial Hospital, 168 North Brent Street, Suite 402, Ventura, CA 93003 or 805-585-3082 or toll free at 888-234-0004
Disclaimer: pcaw.org is produced by the National National Men's Resource Center. This web site seeks to inform and educate men on the many issues that confront them today regarding the possible dangers of prostate cancer. Information presented in this free web site does not necessarily represent the official position of NMRC. Moreover, information in pcaw.org is culled from diverse web sites and information sources. NMRC cannot guarantee the accuracy of these sources. Due to the timeliness of the information, some links will change and/or deactivate without notice.
Information is designed for educational purposes. We are not engaged in rendering medical or psychological advice or professional services. Any decisions should be made in conjunction with your physician or therapist. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with, the use of or reliance upon, any information on our web site.