Depending on the specifics of the case, a number of tests may be indicated and are commonly used at the Dattoli Cancer Center. Some of these tests, or markers, may be used to identify mutant tumor populations, or aggressive tumors in patients without elevated PSAs. Markers of this type include NSE (Neuron Specific Enolase), CGA (Chromagranin A), and CEA (Carcinoembryonic Antigen). A number of other lab tests help to determine whether or not some form of hormonal therapy may be indicated either in the short tern or at a later date. These tests include those that measure levels of Testosterone (total and bio-available), DHT (dihydrotestosterone), DHEA-S (dehydroepiandrosterone sulphate), Estradiol, Prolactin, LH (Luteinizing Hormone) and Androstenedione.
Other evaluative procedures such as Urine Pyrilinks-D (Dpd), N-telopeptide (serum or urine), and Bone Specific Alkaline Phosphatase, are often used in addition to a Bone Mineral Density (BMD) test to establish a baseline for bone integrity. This is especially important for patients undergoing hormonal therapy, which can cause bone loss or resorption. At our Center, a quantitative computerized tomography (QCT) scan is preferred over the Dual Energy X-ray Absorptiometry (DEXA) scan, as the QCT provides more accurate results. Additional tests such as a urine cytology study and NMP-22 bladder cancer marker may be used to evaluate for other malignancies. Tests such as IGF-1 and 2L-6 may be included in a systemic evaluation.
There are other areas within the pathology itself which we may want to examine. Whether or not a cancer has attached itself to a nerve (perineural invasion or PNI) is important because we know that a nerve typically tracts throughout the gland and outside of the gland, and that it can act as something of a conduit for the cancer. In addition, genetic markers like bcl2, p27, p53, and MIB-1 may help to determine the aggressiveness of tumors.
For more detailed information about these laboratory tests:
Blood Tests - What are they for? (81 KB)
Leading Edge Technology
So the diagnosis has been made. Now what do you do? You start by finding a team of professionals who can help you fully understand your options. At the Dattoli Cancer Center, our team of experienced medical experts uses the most state-of-the-art technology to offer more options to patients than ever thought possible. Because each individual case is different, each should be treated as such. Unlike many of the larger institutional cancer centers, the Dattoli Team creates a customized course of treatment for each patient ensuring that they also achieve the highest level of physical, mental and emotional well being. It is our objective to discuss all treatment options at length with our patients, so that they can make informed decisions that are in their best interest and the best interests of their loved ones. And we work in partnership with our patients on their chosen course of treatment to ensure maximum recovery.
Today most prostate cancers can be cured. The extent to which your cancer can be cured will depend upon how early it was diagnosed, and how accurate and appropriate the treatment plan is for your cancer. Perhaps the greater challenge is to eliminate the cancer without impacting the quality of life after prostate cancer. As these cancers are being found at younger ages, many newly diagnosed men have decades of life ahead of them, beyond this experience. We want to do everything we can to ensure that those years will not only be cancer free but also free of those negative post-surgical side effects - impotency and incontinence.
Before we can begin to combat your cancer, we must first learn everything we can about it. Your initial evaluation will include a customized panel of blood tests, performed in our own laboratory, and several in-depth imaging exams.
3-D Color Flow Doppler Ultrasound
Dattoli Cancer Center uses the Hitachi EUB-5500 color-flow Doppler Ultrasound Scanner with a custom "true" 3-D application. Technically referred to as transrectal ultrasonography (TRUS), this is a technique that projects sound waves off the prostate and surrounding organs to create an image. The sound waves are generated by a probe placed inside the rectum. Transrectal ultrasound imaging can in many cases accurately identify the local spread of cancer through the prostate capsule. The technique is also used for real time guidance in conjunction with seed implants, external radiation therapy, and other treatments.
At our institution, color-flow Doppler ultrasound is used because it provides enhanced visualization and greater definition compared to the conventional gray-scale technique. While there is an art to interpreting color-flow Doppler images, tumors tend to show increased blood flow or hypervascularity as findings consistent with malignancy. Tumors are growing faster than normal prostate cells and require more blood to nurture their growth. Tumors therefore tend to create blood vessels around them as they grow, and these can be identified by color-flow Doppler ultrasound. A conventional TRUS typically shows what are called hypoechogenic areas, which are darker shades of gray. A color-flow Doppler ultrasound may show the same image, but provides additional insight into how much perfusion of blood is going into the region, and can reveal whether just one prostate nodule is involved or if there is more cancer dispersed throughout the gland. A unique 3-D application gives us the ability to rotate these images in the computer, displaying the most accurate and complete picture of your gland and surrounding organs. Our Center was the first in the world to adapt this 3-D program to color-flow Doppler ultrasound equipment for the diagnosis and treatment of prostate cancer.
CT scans can identify prostate enlargement and show the size and shape of the gland, but it is not as effective for assessing the extent of cancer or visualizing cancer within the gland itself. While CT scans provide less defined images of the outer prostatic contour and internal architecture, CT images do accurately delineate the spatial relationship between the prostate, rectum and public bones. More contemporary spiral or helical CT scans provide greater resolution while taking less time to acquire the information. The Center's Advanced GE Light-Speed CT Scanner captures high resolution images of the prostate, seminal vesicles, bladder, urethra and rectum, which are required to accurately design your individual treatment plan. This scanner is also equipped to perform QCT Bone Density evaluations for patients undergoing hormone therapy as part of their treatment. More advanced imaging techniques such as magnetic resonance imaging (MRI), bone scan, or ProstaScint scan may also be beneficial in more complex situations.
After two decades of refining the combination treatment protocol, the Dattoli team has developed a program for newly diagnosed patients that incorporates three parts. The first part is 5-6 weeks of daily DART treatments. Individually designed radiation plans are implemented in three stages (or “cones”) – each stage focusing more tightly on the gland and specifically identified tumor locations. Approximately half of the dose required to kill prostate cancer cells is delivered this way.
The second part of combination treatment is Brachytherapy (seed implant). The patient must wait at least 2 weeks after the daily DART treatments for the seed implant. (He may wait as long as 6 weeks.) The seed implant procedure is performed as an outpatient at Sarasota Memorial Hospital, where a special seed implant suite has been designed according to Dr. Dattoli’s requirements. The implant procedure takes about an hour, from set-up until completion. Patients receive differing energies of Pallidium-103 depending on the specific location within the gland (for example, higher energy seeds will be placed within the prostate tumor). This is unique to the Dattoli Cancer Center. These seeds provide the other half of the required radiation dose. The patient will stay as an outpatient in the hospital overnight in an observation status. The catheter is removed during the night of the implant. The patient is discharged early that morning – usually amazed at the ease of the procedure. He will be seen at the Dattoli Center prior to going home that day.
Approximately 90 days following seeding, the patient returns for the third part of treatment. Depending on the original evaluation and the current state of the gland, the patient will typically be prescribed between 3 and 10 additional DART treatments – this time to the periprostatic lymph nodes in the pelvis and abdomen. As these lymph nodes are the most common route for spread of microscopic prostate cancer cells, we have found that this final part of the treatment is an effective assault on any wayward cells remaining after the original daily treatment and beachytherapy.