Doctors lead way in fight against prostate cancer

Two Naples urology practices are the only places in Florida and two of a dozen sites in the world that offer a new device that can pinpoint prostate cancers.

Urologist David Spellberg has a TargetScan in his office on Goodlette Road.

He said it can detect cancers in the prostate — the male reproductive organ that sits below the bladder — earlier.

Men need ultrasounds if their blood tests or digital rectal exams indicate abnormalities.

In traditional ultrasounds, the urologist has to hold onto a probe that goes through the rectum with one hand and take tissue samples with a needle using the other hand.

With the TargetScan, the urologist does not have to hold the probe, which is stationary and scans three-dimensional images of the prostate onto a computer. The urologist uses a needle that bends at a 45-degree angle to take tissue samples from locations on every part of the gland.

"The old machines would give you sort of a one, two-dimensional look at the prostate and you'd have to hold your hand on the probe all the time so you sometimes miss certain areas," Spellberg said.

Because traditional probes have to be moved by hand, they cause the prostate to move and make it difficult to get accurate readings.

"This allows the probe to be locked in place," Spellberg said.

"Because of the three-dimensionality of it, you're able to really see parts of the prostate much better than you were in the past."

He said it's the biggest technological advancement in diagnosing prostate cancer he's seen in his 16-year career.

"The studies from Duke and from Washington University in St. Louis they show that they had about a 30 percent improvement in finding prostate cancer when they compared the two ultrasounds," Spellberg said.

"I think there's a definite improvement in quality in this TargetScan so I have suggested to a lot of patients they should really switch over if we need to do an ultrasound on their prostate."

Used by others

Urologists Sijo Parekattil, Jonathan Jay and Nicholas Franco of Medical Surgical Specialists on Pine Ridge Road also use a TargetScan.

"There's a lot more consistency," Parekattil said. If more tissue samples had to be analyzed a few months later, samples could be taken again from the exact suspicious locations.

He said the device increases accuracy of treatments, too.

For example, in seed therapy, where radioactive seeds are placed throughout the gland to destroy it, doctors can use TargetScan to ensure they place the seeds in the best possible places.

The 3D scan also increases the potential for localized treatments where specific parts of the prostate are destroyed.

Parekattil said the TargetScan enables focal cryotherapy — freezing of cancerous areas — to be more precise.

"Anything you find earlier will allow you to do noninvasive treatments," Spellberg said.

St. Louis-based Envisioneering Medical Technologies developed TargetScan, which is approved by the Food and Drug Administration.

"It takes the guesswork out of it and takes the human error out of it as well," said Bob Mills, company president.

The procedure comes at no extra cost to patients and is covered by Medicare and Medicaid.

Herb Koelling, 74, of Bonita Springs, who recently underwent an ultrasound under sedation at Medical Surgical Specialists with the TargetScan, said he felt no discomfort.

"It's about as difficult as getting a haircut," Koelling said. "There's nothing to it."

Doctors did not detect any cancer cells.

"The odds of finding some later are very minimal," Parekattil said.

Skepticism

Not everyone is sold on the need for the procedure.

Mark Soloway, chairman of urology at the University of Miami Miller School of Medicine, doubts the device's ability to rule out cancer.

"Because cancers can be very, very small, microscopic, it'd be hard for me to believe that you could reliably detect them with ultrasound."

He also said he does not see the need for a device that detects prostate cancer sooner.

"We are actually overdiagnosing prostate cancer in my view," Soloway said.

"If a cancer is very, very small, probably we wouldn't do anything anyhow.

"Many prostate cancers do not grow, could take many, many years."

Soloway said those cancers do not need to be treated but should be carefully monitored.

Prostate cancer has no symptoms in its early stages. More than 10 percent of men eventually die from it, according to the American Cancer Society.

Parekattil and Jay said they would rather treat prostate cancer, no matter how small.

"We don't know who's going to be in the unlucky group," Parekattil said.

Spellberg said he presents all the options to patients and approaches each individually.

If a patient is older and has slow-growing prostate cancer as well as other medical problems, they may choose to monitor it every few months, but he would definitely treat a younger person with a more aggressive prostate cancer. Options include surgery, noninvasive targeted Cyberknife radiation or other localized treatments.

"The goal of all treatments I think in the future is to primarily treat localized prostate cancer and not have to remove the whole prostate," Spellberg said.

"This is a machine that's going to be able to do it."

Soloway at UM doesn't agree with localized treatments of prostate cancer.

"You have to take the entire prostate," he said. "Even if you knew exactly where it (cancer) is, it would not change the current treatment."

Spellberg, who is convinced of TargetScan's benefits, hopes to eventually get one for his Bonita Springs office.

"I think that they're going to be coming out with new software," he said. "I think these software updates will make it better as time goes on."