Clinician-to-Clinician Update Clinician-to-Clinician Update

Latest Diagnostic and Screening Tools for Genitourinary Cancers

July 2015

Cancers of the prostate and bladder are among the most common types of genitourinary cancers. It is estimated that nearly 13% of all new cancers diagnosed in 2015 will be of the prostate, and another 5% will be bladder cancers.1

Prostate Cancer: Stratification of Risk

Optimal management of prostate cancer minimizes unnecessary procedures and treatments for patients with indolent disease. Despite diagnostic gains, about 25% of men with indolent, nonfatal prostate cancer are still overtreated.2 Recent advances in personalized cancer testing are helping reduce that number. The Prostate Health Index (PHI) uses enzyme assays of 3 forms of prostatespecific antigen (PSA) to predict the risk of aggressive disease3 , and the kallikrein panel (4k-panel) uses 4 enzyme assays combined in an algorithm with clinical parameters. The kallikrein panel (4k-panel) has been found to add value in tests for prostate cancer.4

When biopsy is indicated, MRI-guided prostate biopsy with transrectal ultrasound fusion represents the latest technological advance. MRI and transrectal ultrasound images are fused to produce a 3-dimensional reconstruction of the prostate, allowing for improved lesion detection. The targeted biopsies have been found to be significantly more sensitive for detecting prostate cancer.5 The procedure can be performed under local anesthesia on an outpatient basis.

Cystopic-images-Fig1-GU-Consult-443x484
— Cystoscopic images of a patient’s bladder. With white-light cystoscopy (top image), the tumor appears as a single polyp. The blue-light cystoscopy image reveals multiple tumors, which appear in pink-red.

Bladder Cancer: Detection of Subtype

Nearly 80% of patients who initially present with bladder transitional cell carcinoma have non-muscle-invasive bladder tumors. 6 Traditionally, white-light cystoscopy has been used to detect non-muscle-invasive bladder cancer; however, more recently blue-light cystoscopy (Cysview®) has gained use. Cysview combines the tumor photosensitizer hexaminolevulinate with blue-light cystoscopy to improve bladder tumor detection and to facilitate more complete resection, thereby reducing the risk of residual tumor and lessening the rates of recurrence.7

See a brief video presentation on fluorescent (blue light) cystoscopy. University of Minnesota Health surgeon Badrinath Konety, MD, describes the diagnostic tool's use.

University of Minnesota Medical Center’s Institute for Prostate and Urologic Cancers is one of the few centers in the United States with the expertise, technology, and volume necessary to allow for the successful use of these advanced techniques in genitourinary cancer diagnosis. In the last year, our Cancer Care team has performed over 100 MRI biopsy procedures for prostate cancer, and we remain one of the only centers in Minnesota offering Cysview for bladder cancer.

References

1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program Cancer Statistics. Available at http://seer.cancer.gov/.

2. Jacobs BL, Zhang Y, Schroeck FR, et al. Use of advanced treatment technologies among men at low risk of dying from prostate cancer. JAMA. 2013;309:2587-2595.

3. Loeb S, Catalona WJ. The Prostate Health Index: a new test for the detection of prostate cancer. Ther Adv Urol. 2014;6:74-77.

4. Vedder MM, de Bekker-Grob EW, Lilja HG, et al. The added value of percentage of free to total prostate-specific antigen, PCA3, and a kallikrein panel to the ERSPC risk calculator for prostate cancer in prescreened men. Eur Urol. 2014;66:1109-1115.

5. Marks L, Young S, Natarajan S. MRI–ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol. 2013;23:43-50.

6. Heney NM. Natural history of superficial bladder cancer. Prognostic features and long-term disease course. Urol Clin North Am. 1992;19:429-433.

7. Hermann GG, Mogensen K, Carlsson S, et al. Fluorescence-guided transurethral resection of bladder tumours reduces bladder tumour recurrence due to less residual tumour tissue in Ta/T1 patients: a randomized two-centre study. BJU Int. 2011;108:E297-303.

When to refer

We value our relationship with you, your patients and your office staff. We work hard to keep you informed of your patients’ care by providing detailed reports, from diagnosis to treatment and follow-up. Our goal is to provide you with prompt service and communication for the patients that you refer to us.

To schedule a cancer consultation, referral or appointment: 855-486-7226

Collaborative Care

University of Minnesota Cancer Care specialists take a team-centered approach to patient care. Our multidisciplinary team includes radiologists, radiation and medical oncologists, pathologists, and supportive care specialists, all working together to determine the best treatment for each patient. Once a treatment plan is in place, we have the resources and expertise to provide the entire spectrum of care for patients in one location. The referring provider is a valuable and active member of the care team. We value our relationship with you, your patients, and your office staff. We will keep you informed of your patients’ care by providing detailed reports from diagnosis to treatment and follow-up. Our goal is to provide you with prompt service and communication for every patient that you refer to us.

Physician Outreach Program

The Cancer Care Outreach Program is designed to provide education and facilitate knowledge sharing between our team and the medical community. 

To schedule a physician meeting or to visit our facility, contact Melinda Arvold, Oncology Outreach Manager at 612-867-3411 or marvold1@fairview.org.

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