Advances in screening

Carter

About a year ago, a biopsy revealed that Hank Greer had intermediate stage prostate cancer.

But his doctor didn’t know how aggressively they should treat it.

The prostate gland, located beneath the bladder, is roughly the size of a walnut. Prostate cancer is relatively common. One in seven men will be diagnosed with it in their lifetime, but many cases are slow growing and don’t require radiation or surgery.

Dr. Bill Carter, a Charleston urologist, biopsied 12 samples of Greer’s prostate tissue and only found less than 5 percent of one sample tested positive for intermediate stage cancer.

“That’s a tiny volume of cancer,” Carter said.

Typically, an intermediate stage prostate cancer diagnosis calls for eight weeks of daily radiation, a grueling regimen that Carter wanted Greer to avoid if possible.

So he sent his patient to Johns Hopkins Hospital in Baltimore to find out how dangerous Greer’s prostate cancer might be. The hospital used technology called “fusion biopsy” to identify cancerous cells in the prostate by fusing detailed MRI images of Greer’s prostate with a live ultrasound image.

“This showed exactly where the hot spots were,” said Greer, a Roper St. Francis Foundation board member, who lives on Seabrook Island.

The fusion biopsy determined the best course of action for Greer was “watchful waiting.” The Hopkins doctors agreed that his cancer didn’t require radiation.

Greer, whose own brother died of prostate cancer, thought, “We need this technology in South Carolina.”

So that’s what Greer and Carter set out to accomplish. In March, Lowcountry Urology Clinics installed Charleston’s first fusion biopsy machine in West Ashley. Carter owns the independent practice with several other physicians, who are affiliated with Roper St. Francis.

For American men, prostate cancer is the second most common kind of cancer, behind skin cancer, and accounts for more than 180,000 new cases each year, according to the American Cancer Society.

In South Carolina, more than 3,000 men were diagnosed with prostate cancer in 2012 and 484 died from the disease. Black men and patients with a family history of prostate cancer will more likely develop it.

The Centers for Disease Control and Prevention estimate one in 39 men will die from prostate cancer. In fact, only lung cancer kills more men.

But a large group of men who are diagnosed with prostate cancer don’t require aggressive treatment. Instead, doctors recommend a wait-and-see approach called “active surveillance.”

Among those patients with low-risk cancer who are enrolled in an active surveillance program, 70 percent will never require treatment.

“However, that 30 percent, you’re going to miss,” Carter said. The fusion biopsy, he explained, decreases the “miss rate.”

Carter’s colleague, Dr. John Britton, said that the standard ultrasound biopsy, widely used by urologists, isn’t as sensitive as the fusion biopsy. Fusing the MRI image with the ultrasound offers the best of both tools, he said.

“Basically, it allows us to find the prostate cancers that are going to cause life-threatening issues,” Britton said.

Fusion biopsies are not covered by Medicare or private insurance plans. Lowcountry Urology Clinics will charge patients $750 for the procedure. The machine cost about $180,000.

Greer, for one, thinks it was well worth the expense. He spent thousands of dollars traveling to Baltimore for the fusion biopsy.

“Not everybody can afford $2,500 or $3,000 to go outside the state,” Greer said. “It was money that didn’t need to be spent if the technology was here in Charleston.”

Carter championed the new technology, too, but insisted that a standard ultrasound biopsy will continue to serve many patients well.

“Should everyone who needs a prostate biopsy have an MRI-fusion biopsy? No,” he said. “For patients with an elevated PSA (prostate-specific antigen level) or abnormal area in the prostate that can be detected by digital exam, and who are thought to be at risk for having a prostate cancer ... ultrasound-guided prostate biopsy is certainly reasonable.”

Reach Lauren Sausser at 843-937-5598.