Screening For Prostate Cancer

Until recently, standard prostate cancer screening consisted of a PSA blood test (for Prostate Specific Antigen) and DRE (Digital Rectal Exam). However, in October 2011 a U.S. Government Panel released a statement suggesting such screening had a high cost with doubtful survival advantage. In other words, too many men whose screening revealed a suspiciously high PSA or abnormal DRE were rushed into multi-needle biopsies that entailed risks of false negatives, infection, and side effects. In addition, if cancer was diagnosed by biopsy, the men were then encouraged to quickly have a whole-gland treatment such as surgery or radiation, despite their risks of urinary and sexual side effects. The Panel recommended discontinuing routine PSA screening unless men had known risk factors for prostate cancer; and the American Urological Association recommended that doctors discuss the costs of PSA screening with their patients before administering the blood test.

              On the other hand, countless lives have indeed been spared due to diagnosing prostate cancer when it is still contained in the prostate capsule. Just as important, countless men avoided the side effects of whole-gland treatment if their cancer was discovered when it was still small and able to be targeted by focal ablation.

              Dr. Bard offers Power Doppler Sonography of the prostate, a non-invasive way to screen for prostate tumors with their abnormal blood vessels. It actually shows any suspicious area so it can be selectively targeted for biopsy. This eliminates the so-called blind biopsy (Transrectal Ultrasound or TRUS-Guided biopsy) which often misses cancer because ordinary ultrasound can't distinguish tissue with accuracy. The precision of a targeted biopsy eliminates the need for a large number of random needles.

 

Screening for Breast Cancer

 

The current standard in screening for breast cancer is mammography. However, this imaging tool misses some breast tumors, especially in women with dense breasts. Published data suggests that sonography can play an important role in detecting tumors that mammography misses. In fact, over 94% of cancers seen only on ultrasound were invasive tumors with average size of 9-11 mm, and in the studies where staging was detailed, 91% were node negative.[1]

              Power Doppler Sonography, such as that used by Dr. Bard, adds increased accuracy to breast imaging evaluations with ordinary gray scale ultrasound because it shows higher blood flow speeds, often a sign of cancerous activity in the breast. Studies have shown that suspicious blood flow identified by pre-surgery Power Doppler scans corresponds very well with the size, location and aggression of actual tumors that are then surgically removed. Thus, Power Doppler brings an important dimension to breast cancer detection.

While it has not been established that sonography should be used in place of mammography, ultrasound offers the following advantages:

  • Well-tolerated
  • Widely available
  • Non-invasive
  • Relatively inexpensive
  • Can distinguish cysts (fluid-filled masses) from cancerous tumors without needle sampling
  • Ease of image guidance for breast biopsy

If there is a down side, it is the shortage of medical personnel skilled at reading breast sonograms. This suggests the importance of seeking expert sonographers when breast ultrasound is indicated or desirable as a complement to mammography.

              It has not been determined if there are specific groups of women who would most benefit from ultrasound breast exams alone, or in conjunction with mammogram screening. Women who should consider ultrasound scanning of the breast include those at risk of breast cancer because of personal or family history and the presence of fibrocystic (dense) breast tissue which increases cancer risk.

Screening for Other Cancers

Dr. Bard continues to research forward-looking uses for advanced ultrasound, including early detection of ovarian cancer, thyroid and parathyroid cancer, and other conditions both cancerous and noncancerous that can threaten life and lifestyle.

 

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