Quoc-Dien Trinh, MD, urological surgeon at Brigham and Women’s Faulkner Hospital
According to the American Cancer Society, one in every eight men will be diagnosed with prostate cancer in their lifetime.* In its early stages, prostate cancer has no symptoms. However, when it goes undetected, later stage prostate cancer presents with an array of symptoms, including trouble urinating, decreased force in the stream of urine, blood in the urine, blood in the semen, general pain in the lower back, hips or thighs, discomfort in the pelvic area, bone pain and erectile dysfunction.
That’s why routine prostate cancer screenings are so important. “As a provider, if you’re concerned that your patient might have prostate cancer based on a physical exam and/or blood work, the next step is traditionally to order a biopsy,” says Brigham and Women’s Faulkner Hospital urological surgeon Quoc-Dien Trinh, MD.
In a standard transrectal biopsy for prostate cancer, a small probe is inserted into the rectum and the surgeon uses a needle to collect samples for analysis. “The problem with this approach is that we are not guided by any additional information,” says Dr. Trinh. “We just go in and take 12 systematic samples across the prostate.”
To make the process more accurate, in bore MRI-guided biopsy has been used recently. Here, the patient is sedated and placed in an MRI machine. The radiologist then uses the imaging to guide their needle. Because the process involves sedation to keep the patient still in the MRI machine, the process is more time-consuming. But, thanks to new technology, the benefits of MRI-guided biopsy can be had in a convenient office procedure. With fusion biopsy, now performed by Dr. Trinh and several of his colleagues in the Department of Urology at BWFH, images taken from an MRI can be overlaid with those taken from an ultrasound probe in real time, allowing the surgeon to easily and quickly pinpoint the areas of concern and biopsy under local anesthesia right there in the exam room.
“The procedure itself takes just 10 to 15 minutes,” explains Dr. Trinh. “Best of all, there is no time needed to recover from sedation or general anesthesia.”
If prostate cancer is confirmed after a biopsy, Dr. Trinh works with each individual patient and their multidisciplinary care team to develop a plan of care tailored to their unique needs.
“Many prostate cancers that are not aggressive don’t require any treatment at all while there are others that are aggressive and require a combination of treatments including surgery and/or radiation therapy,” he explains. “Some cases may be amenable to focal therapy, which is offered here in the form of high-intensity focused ultrasound (HIFU).”
HIFU is a new procedure that Dr. Trinh and his colleagues have recently brought to BWFH that sends targeted ultrasound waves to one specific area to kill the cancer cells.
“HIFU may have lesser impact on quality of life,” says Dr. Trinh “But we are still waiting for long-term data to know how effective it is compared to traditional treatment options like surgery and radiation therapy.”
To learn more about prostate cancer, including risk factors, screenings, diagnosis and treatment options, visit BWFH.org.
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