Another Biopsy Alternative? Super Duper Ultrasound

The results of my PCA3 Plus test have at least given me some confidence that I have a little time to fully research my options before I undergo an invasive procedure like a biopsy.

Newer ultrasound technology is another step that can be done before a prostate biopsy.  Like the PCA3 test, it’s not yet widely accepted as a substitute for a biopsy.  Even so, you can find a number of research studies on ultrasounds for this purpose.  Many show them to be quite promising, especially in combination with other diagnostics.  They go by a number of different names and acronyms.  “Color Flow Doppler” (CD or CFD) and “Power Doppler” (PD or PDI or PDUS or PD-TRUS) are typical names.  It might be called a sonogram, sonography or ultrasound.  Many are “3D” or “4D”.  They all apparently give a lot more information than the generic ultrasound most urologists use.  This is apparently because these newer techniques not only see basic tissue features, but also the flow of blood at some level.  Blood flow is apparently altered in tumors or cancerous regions, so this type of ultrasound may be able to detect that.

In fact, according to my friend, Google, this technology is widely accepted and used in other areas of radiology and diagnostic medicine.  Those range from locating brain and breast tumors to getting 3D images of an unborn child.  There are a lot of studies on using them to detect prostate cancer, to help stage surgery for biopsy proven prostate cancer and even as an aid during a prostate surgery or biopsy.  The results seem to vary as to things like sensitivity, specificity and other measures, but most seem to agree that these newer ultrasounds have legitimate use on the prostate, even if not yet a replacement for a biopsy.

There are also a number of urologists and physicians that are already using this type of ultrasound specifically for prostate cancer detection and treatment in their own practices.  I contacted some and found that the costs seem to range from $600 to $1000.  This cost may be covered by some insurance companies, though you’re likely to have to file an out-of-network claim on your own.  The link below has a partial list of people doing these ultrasounds.  I have no experience with any of those on the list.  Most are licensed physicians or urologists, some in a private practice devoted to prostate health.  Some only do this type of ultrasound in conjunction with a biopsy, while others do it as a separate procedure.  Some also appear to be proponents and/or providers of alternative and natural  treatments and seem to be a bit more “commercial” than most other physicians.  So, be sure to carefully research any of them if you are considering one for a second opinion-

It’s pretty clear that most radiologists and urologists don’t yet think any type of ultrasound should be used instead of a biopsy for prostate cancer detection.  On the other hand, there are a ton of studies regarding ultrasounds and the prostate, many of them showing convincing results.  Given the relatively low cost and the fact that insurance will cover it in some cases, I suspect there is a real benefit here for some patients.  It’s worth asking your own physician about one, before having a biopsy.

I have a “3D power doppler” ultrasound scheduled for a week from today.  If I could find a practitioner doing this locally, it would be a no-brainer for peace of mind, at least in my situation.  Unfortunately, it seems my area lacks a specialist doing this type of imaging of the prostate, so there will be additional cost and hassle for travel.  Looking on the positive side, it is an excuse to use up frequent flier miles on a bankrupt airline for an overnight trip.  Perhaps the greatest benefit- I also get to visit a couple friends in the process!  So, I’m not seeing a big downside in my situation, given that it is minimally invasive, has few potential risks or side effects and isn’t costing me much time.  As for the benefit vs. cost, I guess I’ll have to wait to see the results of the procedure and the insurance bill to decide that…