By Jerry Berger | Beth Israel Deaconess Medical Center Staff
Joel Carpenter received some bad news at the worst possible time – minutes from the close of business on a Friday afternoon. The answers to his questions about his Stage One prostate cancer diagnosis would have to wait. But not that long.
A post 5 p.m. call was returned at 8:05 a.m. the following Monday and Carpenter sat down with Beth Israel Deaconess Medical Center Prostate Care Center surgeon Dr. Martin Sanda, later that week.
«When you find out that you have a disease like this you want to get to the expert as quickly as you can because you have a thirst for knowledge,» says Carpenter, 50, who underwent a successful prostatectomy in May and was back to work 3 weeks later. «There’s a whole bunch of things you don’t know.»
And filling that knowledge gap accurately is precisely one goal of the Prostate Care Center, says Dr. Glenn Bubley, a medical oncologist and – along with Sanda and radiation oncologist Dr. Irving Kaplan – one of the center’s three co-directors.
«The Prostate Care Center is set up to help patients who are newly diagnosed get through the morass of decision-making,» says Bubley. «The anxiety these patients have is palpable, because they feel ‘gosh, if I make the wrong decision here I’m going to die of this disease.’ That’s not the way it works.»
«They took me through, in a very precise and articulate and understandable way, what the options were,» says Carpenter. «They gave me all the information there is to make this kind of decision… including a pretty clear discussion of what they don’t know.»
For many patients, the first step will often be a trip to BIDMC’s state-of-the-art diagnostic tool which combines the latest in magnet resonance imaging technology with the latest in software.
On the hardware side, the implementation of a General Electric high field strength MRI unit operating at 3T (T for Tesla, or a unit of measuring magnetic strength) and the development, by Medrad, Inc., of a specialized coil to detect the MRI signal enable imaging of the prostate gland at higher spatial resolution than previously possible.
This capacity has been combined with 3TP (for time points), a software analysis tool developed by Israel’s Weizmann Institute and commercialized by 3TP Imaging Sciences, LLC. The software yields color-coded images that display benign images in green – and cancerous lesions in red.
«This technology helps find cancers that routine biopsies miss,» says Sanda.
Once a diagnosis is confirmed, it’s time for the patient and his family to weigh the options from the team.
«The first big branch point is whether or not they should be considered for a watch and wait protocol,» says Kaplan. Because prostate cancers grow slowly, there is a potential to defer treatment, perhaps as long as an entire lifetime, depending on the patient’s age.
If watchful waiting is ruled out, a patient faces two additional choices – surgery or radiation. But within these broad categories are a number of options including brachytherapy – the implantation of radioactive «seeds» or the use or external beam radiation.
«If everything we know about the patient gives me a very firm conviction that the cancer is confined to the prostate, those are the ideal candidates for the brachytherapy,» says Kaplan, describing the procedure as «a rifle shot aimed at the prostate.»
«If I think it is likely there will be cancer outside the prostate, that’s when we tend to recommend external beam radiation,» he adds, describing this approach as «more of a shotgun. It trea
