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 talks about using MRI guided biopsy with the 3T Multi-Parametric MRI – BlueLaser™ vs TRUS.
Health Professional Radio – Prostate Cancer Screening
Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Thank you so much for joining us on the program here today. With over two hundred thousand men diagnosed every year with prostate cancer, conventional PSA screening has been called into question by the US government because of some controversial side effects that leave men with some sexual and urinary impairments. Our guest in studio today is Dr. Dan Sperling, Medical Director of the Sperling Prostate Center with us to discuss using MRI-guided biopsy with 3T Multi-Parametric MRI Technology. Welcome to the program Dr. Sperling.
Dr. Dan Sperling: Thank you, it’s a real pleasure to be here today and to go over some of the new technology that we’re utilizing and how this may benefit many people.
N: Great. Now you’re the Medical Director of the Sperling Prostate Center, where is the Prostate Center located?
S: We have locations in Delray Beach, Florida as well as in Westchester, New York, we have a site as well in California in Santa Monica.
N: So is your background in oncology or in imaging or is it a mixture of both?
S: It’s a mixture of both. I’m a specialist in radiology, uroradiology specializing and dealing with prostate issues and cancer of the prostate gland. Well I’m board certified in diagnostic radiology and also trained in interventions using image-guidance MRI to do inside the MRI procedures which is really becoming not just for prostate cancer to many other disease processes are very, very good choice method of treatment.
N: Well then let’s talk about this MRI-guided biopsy. Is this some technology that’s been in use for quite a while?
S: So I’ve done the most of these in United States of actual biopsies inside the MRI. I’ve done thousands of them, I started doing this back around 2009, the only other place that was doing it before me was in Holland. They have some biopsies inside the MRI, I traveled out there and collaborated with them and learned how do those same procedure and biopsy because for the first time with prostate cancer, using MRI will…more tissue accurately and the target it.
N: Talk a little bit about why it is difficult to accurately image the prostate without using these advanced tools?
S: Sure, so the main problem with the tools before MRI or Multi-Parametric MRI became available was ultrasound was the primary imaging modality to look at tumors. And the ultrasound is a good technology for certain areas of the body just not very good for the prostate gland. A lot of times there are calcifications in the prostate gland, there are a lot of nodules in the middle of the prostate gland that are normal. As people age you get a lot of nodularity or what’s called BPH in the central or transition zone of the prostate gland and these obscure our tumors very easily, so it’s a very very hard to see tumor with the ultrasound and then Doppler which was added on later to standard ultrasound technology’s also very limiting in terms of only looking at one fixed time point at our blood flow to the prostate when with MRI which can look at 50 different time points and then actually cahrt out different contrast kinetics so we can get a lot more information with the MRI than with ultrasound.
N: Sometimes when we talk about traditional methods of treating certain diseases there’s a bit of resistance to change. Are we talking about a lengthy transition before this becomes extremely mainstream or is it well on its way to becoming the new norm of prostate cancer screening?
S: I think we’re midway in terms of prostate cancer evaluation. Many centers in the United States are now routinely using Multi-Parametric MRI before doing a biopsy. That way they know if biopsy’s actually necessary and if they do a biopsy it’s more they can actually target more effectively the tumor tissue. Unfortunately most sites are not doing the biopsy inside the MRI so it’s not the ideal type but it’s still better than completely blind biopsies and ultrasound. There is though at the beginning when I started doing this a number of years ago, there was a lot of resistance. Most other doctors would say “Oh the MRI has no utility,” they’re weren’t aware of the new technology and were against it and now there is much more of an awareness and acceptance by many doctors still at the country and it’s continuing to grow which is a very positive development.
N: How timely are the results when it comes to reading the biopsies? Are the results much faster or simply more detailed?
S: So the MRI, the results from an MRI examination are pretty much immediate right after the patient comes off the table. I sit down with the patient and we go through the images. I could show them what they have and how aggressive it is. If there is something that…suspicion we can bring them back in that same day and bring them into the MRI room again, they lie on their chest, we use a specialized plastic tube that goes into the rectum, it’s not painful and then what we do is insert and sample to get tissue with a specialized biopsy device. So we actually image the biopsy device localized directly in the tumor while the patient is inside the MRI exam and that’s a critical piece. If you’re getting a biopsy done you want to have it done inside the MRI because then you’re actually know you’re getting the right tissue. Now I have people will come to me diagnosed with low grade cancers, some of the blind trans-rectal ultrasound approach, I will bring them into the MRI machine and inside the MRI we biopsy them and tell them they actually have aggressive tumors and that dramatically will change the approach to treatment because if you blindly biopsy may scrape the edge of the tumor, get less aggressive cells but when the MRI, you can actually biopsy right in the middle of the tumor and we really get an accurate assessment of how aggressive the tumor cells are.
N: Does this new Blue Laser take into account as you mentioned earlier, age – is it as accurate for a very old person as opposed to someone maybe having some experience say in their mid-30s or even 20s if that is even something that you’ve come across?
S: You bring up an excellent point. I mean who is the right patient for MRI and who are the right people to get it in terms of age factors. The MRI is actually good for all ages, although of course most men start to develop prostate cancer or at risk for it over 50 years and older but there is a wide variety and I’ve seen guys in their 30s and guys in their 90s that developed it for the first time, so there’s a wide variety of patients or people who develop it at different age groups. But what is really important with the MRI what is the really utility is what guys who have enlarged prostates and many men have big prostates and when you try to biopsy them with the blind trans-rectal ultrasound approach, these tissues is stretched out. The area that you need to biopsy is really spread out very far apart and it’s very hard to really see if there’s tumor and biopsy it accurately with ultrasound. With MRI we can biopsy any part of the prostate and reach it accurately and make sure we don’t miss tumor so it’s really particularly good for men with enlarged prostates which is a very large group of people.
N: Where can we go and get some more information about this procedure?
S: A great source of information is my website, it’s www.sperlingprostatecenter.com, we have hundreds of article on there that are written and we have many resources in terms of other articles and research and I recommend people going to that website and really learn a lot about what we do and other options as well.
N: 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 talking about MRI guided biopsy with the 3T Multi-Parametric MRI. It’s been great having you here in studio today with us Dr. Sperling.
S: Thank you, it’s been a pleasure. Thank you for having me.
N: Thank you. 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.