Guest: Dr. Dan Sperling
Presenter: Neal Howard
Guest Bio: Dan Sperling, MD, DABR, is the Medical Director of the Sperling Prostate Center and the Sperling Diagnostic Center based in Florida and New York. He is certified as a radiologist by the American Board of Radiology, and licensed in New York, New Jersey and Florida, and co-author of the new patient book Redefining Prostate Cancer.
Segment overview: Dr. Dan Sperling, Medical Director of the Sperling Prostate Center discusses the 3T Multi-Parametric MRI – BlueLaser™ that provides a way for experts to gain the best available imaging when detecting prostate cancer.
Health Professional Radio – Detecting Prostate Cancer
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us today. Our guest in studio is Dr. Dan Sperling, Medical Director of the Sperling Prostate Center here in studio today to discuss 3T Multi-Parametric MRI-Blue Laser as it provides a very good way to gain the best available imaging when trying to detect prostate cancer. Welcome to Health Professional Radio Dr. Sperling.
Dr. Dan Sperling: Thank you very much Neal. I’m very happy to be here and to have a conversation with you regarding some of this exciting new technology, it’s really helping a lot of people.
N: I thank you so much for coming and when we’re talking about new technology, let’s first give our listeners a little bit of taste of the old or I guess traditional technology that has been in use and a bit of it has come under fire by the US government.
S: Yes. So PSA, prostate specific antigen is in a study that’s tested in the, there’s a screening tool used from the routine blood test to look at elevations and if there is an elevation, traditionally the urologist would do a blind biopsy approach using ultrasound called the TRUS biopsy. So that was the old way of doing things and for many, many years was the standard of care for elevated PSA. What happened was the approach had a very low yield about 30% detection of prostate cancer and there was a risk of infection with each biopsy that they did. There’s also risk since the ultrasound is not good at imaging the prostate that they would miss certain tumors and then patients will go undiagnosed which was obviously very dangerous. So that’s how MRI came into the picture as the new frontier and the new way of really diagnosing prostate cancer in a much more effective way.
N: Now you’re talking about MRI but even above and beyond MRI, there’s some new exciting MRI technology that you’re here to discuss as well.
S: Yes. So MRI was used for many years with the prostate, that the problem with the MRI or the old type of MRI that was used it was that there was no processing done which I’m really saying we’re not able to see a functional aspects of the tumor. With the new Multi-parametric prostate MRI technology and specifically some of the protocols we use with Blue Laser technology we are able to process the MRI images after they are done and look at tumor functionality which means we can see cells clustering together and blocking flow of the water molecules. We can look at replacement of the normal watery tissue of the outside of the prostate with dense tumor cells and we can see actually angiogenesis or new blood vessel formation within tumors. So really have a much more Intel look at the prostate gland and once we see these areas we can actually give an estimation of how aggressive prostate tumors are, localizing properly and then we can go on targeting and eventually biopsy these tumors in the MRI machine.
N: In your experience have you encountered patients who have been misdiagnosed based on the old technology and once this Blue Laser is implemented, you’re able to catch it and still offer effective care?
S: So I have many patients that have, actually hundreds of patients at this point that I’ve seen they had the blind biopsy trans-rectal ultrasound approach. Tumors were missed and they went to 5 different sessions of biopsies and over 80 needles inserted into the prostate and still no diagnosis but their PSA kept elevating to very high level. Some guys came in with PSAs over 40 and a normal PSA is within the 4 or elevated, an elevation of about 4. So when I saw these cases when we do the MRI we actually found a focus of tumor, areas of tumor in the prostate gland and I was able to sample and biopsy these tumors in the MRI machine which is 2-3 samples and get a diagnosis and following these guys could undergo treatment so it was really lifesaving in many instances.
N: How cost effective is this new technology? Normally when something new comes out even if it’s extremely effective there is a period of time where it is a little bit less cost-effective than the traditional. Is there any difference here?
S: Yes. So MRI is actually proven in many studies to be more cost-effective than jumping right to a biopsy after an elevated PSA and that’s why PSA has gotten a really bad rep. It’s a good screening tool but when you use it in conjunction with the MRI, you can actually make a decision whether or not the patient needs a biopsy. So someone may have an elevated PSA and it could just be secondary or related to an enlarged prostate gland, it could be due to inflammation or prostatitis which many men have and those individuals of the MRI does not show any tumor do not get a biopsy and there is risk with the biopsy. There’s always a risk when you biopsy to direct on that way almost all biopsies are done, that you can suffer something called urosepsis which is a severe infection, a uroseptic infection. So the MRI can save people from undergoing unnecessary procedures and thereby protecting them from complications which really takes a huge burden off the health care system. Plus you may find areas of the certain specs of tumor that are very well-grade, non-aggressive and maybe don’t even need treatment, you can just watch them do what’s called active surveillance. And then there’s patients who not have to undergo a needless surgery and undergo those complications from those types of procedures, so it’s surgery or radiation. So there are a lot of benefits the MRI and it really does help the health care system save a lot of money.
N: Once you’ve identified the tumor as you say and sometimes finding something that can simply be monitored, once you’ve pinpointed it can you rely on a lesser technology say go back to monitor it now that you’ve identified it makes it so that there’s no more hiding it? Is that something that happens or once you used Blue Laser is it best to continue to use it even for monitoring?
S: If you’re going to do monitoring, it’s much better to continue with the same technology that detected the tumor because what happens is ultrasound, even Doppler ultrasound which actually looks at vascular flow is inferior to MRI. With MRI we can look at actually 50 different points in time of blood flow into the prostate and create specialized curves so we can look at the flow dynamics and contrast kinetics which you cannot see with ultrasound. So people will have always or people have raised that question ‘Can you go back to maybe an ultrasound which is cheaper than the MRI and see how tumors’ progressing?’ And you really are not getting that same quality imaging and it’s tough to really follow tumor tissue. You want to be really careful that if a tumor does get more aggressive as you’re following it that you tell the person or advice to go had it treated at the right time. So it’s very important to stay with the initial technology such us MRI and Blue Laser that have detected it.
N: Do experts need to come into the Sperling Prostate Center in order to learn about this or do you have individuals that go to different facilities for training purposes?
S: So we advise most people to come in if they’re able to, to come into our center because that what I do is which is unique is I will sit down with people who are getting the MRI examination after it’s done and go through with them for over an hour explaining to them the science, the technology behind it and then going to their individual case which most people find very helpful in terms of going on to the next steps whether it be active surveillance, treatments, some type of treatment that they find that to be very, very helpful. There are centers now and a lot of centers that I have trained and supervised that are starting to provide MRI examinations and some of them are good but we can put them in contact. People cannot travel to us we can, put them in contact with those centers.
N: Great. Where can our listeners get much more information about this new technology and the Sperling Prostate Center itself?
S: I would point them towards www.sperlingprostate.com, that’s our website and we did hundreds of articles on that regarding all areas of MRI and it really has a wealthy information most people find to be very, very helpful.
N: I thank you so much for coming in today Dan.
S: Thank you, my pleasure. Thanks for having me.
N: Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm, you can subscribe to this podcast on iTunes. You’ve been listening to Health Professional Radio, I’m your host Neal Howard in studio with Dr. Dan Sperling, Medical Director of the Sperling Prostate Center discussing 3T Multi-Parametric MRI-Blue Laser Technology.