INTERVAL PROSTATE CANCERS: DIAGNOSIS BY 3-D ULTRASOUND AND 3-TESLA MRI

Transcription

1 INTERVAL PROSTATE CANCERS: DIAGNOSIS BY 3-D ULTRASOUND AND 3-TESLA MRI ROBERT L. BARD, M.D. DIRECTOR BIOFOUNDATION FOR ANGIOGENESIS RESEARCH & DEVELOPMENT 121 East 60 th St. Ste. 6A New York, NY

2 INTERVAL CANCERS NAME COMES FROM BREAST CANCERS FOUND 6 MONTHS BY PATIENT SELF EXAM AFTER NORMAL MAMMOGRAM RESULTS CANCERS ARE HIGHLY AGGRESSIVE 6% OF PROSTATE CANCER NOTED WITHIN 6 MONTHS OF NORMAL CLINICAL OR SONOGRAM EXAM ROLE FOR SCREENING MALE PROSTAGRAMS

3 OBJECTIVES DIAGNOSE AND STAGE INTERVAL PROSTATE CANCERS IMPROVE SURVIVAL SINCE LATE DETECTION = POOR PROGNOSIS EVALUATE THERAPY BY MONITORING RESPONSE OF TUMOR VASCULARITY

4 2005 BIOPSY RESULTS 82% MISSED CANCER MEN UNDER 60 65% MISSED CANCER MEN OVER 60 ANTERIOR TUMORS MOST MISSED WHEN COMPARED WITH OPERATIVE PATHOLOGY SPECIMEN FINDINGS HRICAK H UPDATE IN IMAGING NEW YORK ROENTGEN SOCIETY 2005

5 DOPPLER FLOW PATTERNS BENIGN FLOW IS MICROVASCULAR MALIGNANT FLOWS ARE NOT MICROVASCULAR SUGGESTING VISUALIZATION OF FEEDING VESSELS IN HIGH GRADE CANCER LOUVAR E ARRS 1996 PATHOPHYSIOLOGY OF INCREASED PROSTATIC COLOR DOPPLER FLOWS

6 TREATMENT RESPONSE VASCULARIZATION OF TUMORS DETERMINES BIOLOGIC BEHAVIOR REDUCTION OF VESSELS IN TUMOR CORRELATES WITH THE RESPONSE OF THERAPEUTIC EFFECTIVENESS CORNUD F PROSTATE IMAGING JOURNEE FRANCAISE RADIOLOGIE 2005

7 MATERIALS AND METHODS PROSPECTIVE STUDY 30 MONTHS 3D / DOPPLER / MRI 456 PATIENTS AGE D IMAGING 3.0 T MRI SCANS WITHIN 1 WEEK TIMEFRAME 22 INTERVAL CANCERS LOCATED 13 ISOECHOIC LESIONS

8 SURGICAL ZONES SONOGRAM ZONAL ANATOMY bladder Central Zone Peripheral Zone rectum 70% CANCERS FORM IN PERIPHERAL ZONE

9 VASCULAR ZONAL ANATOMY CENTRAL ZONE 2 MM DIAMETER VESSEL DEMARCATES CENTRAL ZONE

10 5 MM TUMOR NOT PALPABLE - DIFFICULT TO BIOPSY ANTERIOR RIGHT CAPSULAR VASCULAR EROSION

11 3 CANCER GRADES - 6,7,8 IN ONE PATIENT S EXAM GL 3+3 POSTERIOR GL 4+3 MID GL 4+4 ANTERIOR

12 OCTOBER 2003 FEBRUARY 2004 GLEASON 4+4 VASCULARITY DECREASES AFTER 3 MONTHS OF ANDROGEN DEPRIVATION THERAPY

13 POST RADIATION PSA RISE SEEDS IN BASE 2 yrs NEW TUMOR IN APEX ANTERIOR VESSEL SHOWS NEW TUMOR

14 ANTERIOR TUMOR OUT OF ENDORECTAL COIL FIELD UNDERESTIMATION L BASE Courtesy of Dr. Anno Graser, Department of Clinical Radiology, University of Munich

15 GL 4+4 MISSED BY 1 ST BIOPSY VASCULAR ANTERIOR RIGHT BASE 11 MM TUMOR PSA 0.48 BULGING CAPSULE

16 ANTERIOR GLEASON 3+3 NON PALPABLE TRANSVERSE US TRANSVERSE MRI

17 7 MM ANTERIOR GL 4+4 TUMOR VASCULARITY INDICATES HIGH GRADE LESION

18 ANTERIOR GLEASON 4+4 NON PALPABLE CANCERS RECEIVE DELAYED RX HIGH MORTALITY FROM NON PALPABLE TUMORS

19 ANTERIOR CENTRAL ZONE 6 MM GLEASON 3+4

20 94 Y/O ANTERIOR TUMOR GOLOBIN 8 MM VASCULAR TUMOR BREAKING THROUGH CAPSULE

21 HIGHLY VASCULAR INTERVAL TUMOR NEW RIGHT APEX YR HX 3+3 LEFT BASE NOTE BULGING ANTERIOR RIGHT CAPSULE

22 MASSIVE INTERVAL CANCER GRAHAM 2/05 MILD BPH 5/05 90% GLAND CANCEROUS

23 INTERVAL ANTERIOR APICAL CANCER OLD GL 3+3 MIDGLAND NEW GL 4+4 APEX NEW VASCULAR CANCER CROSSES APEX MIDLINE

24 ANTERIOR GL 7 TUMOR ANTERIOR GL 8 TUMOR POSTERIOR GL 6 TUMOR GL 3+3 GOLDSTEIN NEW NON PALPABLE TUMORS WITHIN CAPSULE

25 BLADDER INVASION T2 MRI TRANSVERSE COMPUTER AIDED MRI

26 TUMOR SIMULATING BPH NOTE ANTERIOR TUMOR ERODING CAPSULE NOTE LEFT PERIPHERAL ZONE VASCULAR MASS

27 BLADDER INVASION 12/04 5/05 GLEASON NOTE BLADDER WALL TUMOR

28 ANTERIOR TUMOR INVADING BLADDER

29 CE MRI-BLADDER INVASION

30 TUMOR SIMULATING BPH ANTERIOR TUMOR IS ECHOGENIC VARIANT LEFT NODULE ORIGINATES IN PERIPHERAL ZONE

31 CE-MRI SHOWS? BPH AS PC TUMOR EXTENDS FROM ANTERIOR TO POSTERIOR

32 CE-MRI OF INTERVAL CA GL 6 L BASE 9/2005 CE+ CAD MRI 5/06

33 RT SV INVASION GL 4+4 NEW LESION DILATING SV RX SEEDS 9 YRS RISING PSA PROSTATE AVASCULAR

34 3D-PDS VASCULAR MRI PHILPOTT 3TP RIGHT BASE AND LEFT CENTRAL ZONE TUMORS

35 3-D PDS VS 3TP MRI

36 RADIATION FAILURE SEEDS + EXTERNAL BEAM GLEASON SEED NO SEED NOTE LEFT EXTRACAPSULAR EXTENSION 2006

37 SEED+EXTERNAL BEAM FAILURE PSA EXTRACAPSULE EXTENSION 2004 S-MRI 2004 RRX 2006 CE-MRI

38 3-D PDS VS 3TP MRI ANAPLASTIC APEX CARCINOMA PSA 0.3

39 VASCULAR CAPSULE SPREAD 3D-ANGIO FORMAT 3 TP MRI SAME PATIENT NOTE VASCULAR IRREGULARITY

40 86 y/o Physician Refused Biopsy PSA 20 (4/06) 31 (5/06) NON PALPABLE HIFU 5/06

41 HIFU OF 86 YEAR OLD PHYSICIAN-BIOPSY REFUSED TREATED TUMOR BECOMES ECHOGENIC HIFU OF PHYSICIAN

42 ANTIOXIDANT TREATMENT OYEN PROTOCOL - BELGIUM VITAMIN E, SOY & SELENIUM 90 PATIENTS STABLE/IMPROVED 6 MONTH PERIOD GLEASON 6,7,8 & 9 1 BPH PATIENT DEVELOPED GL 6 TUMOR BARD R 1ST WORLD CONGRESS INTERVENTIONAL ONCOLOGY CERNOBBIO 2006

43 GLEASON 7 ANTI-OXIDANT THERAPY 4 MONTHS 5/2005 PSA 33 9/2005 PSA 6

44 THANK YOU!