this abstract below repudiates one of the more idiotic scams I have witnessed pushed onto patients. I welcome any findings to the contrary.
2004 by the American Institute of Ultrasound in MedicineJ Ultrasound Med 23:623-630 • 0278-4297
Color and Power Doppler Sonography in the Diagnosis of Prostate Cancer
Comparison Between Vascular Density and Total Vascularity Peter H. Arger, MD, S. Bruce Malkowicz, MD, Keith N. VanArsdalen, MD, Chandra M. Sehgal, PhD, Anson Holzer, BA and Susan M. Schultz, RDMS
Departments of Radiology (P.H.A., C.M.S., A.H., S.M.S.) and Urology (S.B.M., K.N.V.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania USA.
Address correspondence and reprint requests to Peter H. Arger, MD, Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. E-mail: peter.arger@uphs.upenn.edu
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.
Objective. Advances in color flow Doppler (CFD) and power Doppler imaging (PDI) have potential for prostate cancer diagnosis. Previous reports based on qualitative assessment suggest that hypervascularity increases likelihood of prostate cancer. Our objective was to compare 2 methods of vascularity assessment using PDI: total vascularity (TV) and vascular density (VD). The goal was to determine whether quantitative Doppler vascularity correlates with the likelihood of prostate cancer. Quantitative measurements were compared with subjective visual analysis of images. Methods. Ninety patients before biopsy had gray scale sonography, CFD, and PDI. Histologic analysis showed adenocarcinoma, prostate intraepithelial neoplasia, benign prostatic hypertrophy/prostatitis, and benign findings. The CFD and PDI images were analyzed for vascularity by (1) integrating the number of blood vessels over an imaged area (TV) and (2) integrating the number of vessels over a unit area of tissue (VD). Images were also assessed visually. VD, TV, and visual assessment were compared with one another and histologic findings. Results. Mean volume was not different. In each pathologic group, vascularity extent measured by TV and VD ranged from low to high. Disease groups did not exhibit a substantial difference in vascularity by either quantitative or qualitative analyses. Regionally, central gland TV was not significantly more vascular than peripheral gland TV except in benign prostatic hypertrophy. However, peripheral gland VD was 2.5 times greater than central gland VD. Seventy-one percent of the 31 focal hypoechoic lesions were hypervascular. Only 23% were carcinoma. Conclusions. Pathologic categories were not separable by apparent vascular measurement. All pathologic categories showed low, moderate, or high vascularity; thus vascular areas by themselves did not distinguish cancer types, nor did focal hypervascular hypoechoic areas increase the likelihood of cancer. These imaging techniques provided no further resolution of tumor discrimination over multiple biopsies of the prostate.
Key Words: color flow Doppler imaging • power Doppler imaging • prostate cancer • total vascularity • vascular density
Abbreviations: BPH, benign prostatic hypertrophy • CFD, color flow Doppler • PDI, power Doppler imaging • PIN, prostate intraepithelial neoplasia • PSA, prostate-specific antigen • TV, total vascularity • VD, vascular density
Friday, February 29, 2008
another old link related to me
Home
Medical Executive Committee
Manatee WelcomesNew Physicians
The Lowdown on High Blood Pressure
New Therapy Helps Keep Coronary Arteries Open
Eat, Drink and Rehydrate
Small Incision Reaps Big Benefits
Sleep Apnea
Sounding Off About Coughs
Community Events
The ABCs of SARS
Past Issues
Small Incision Reaps Big BenefitsMinimally Invasive Surgery for Urology Procedures
On the LookoutAccording to the American Cancer Society,symptoms of kidney cancer include:
Blood in the urine
Low back pain (not from an injury)
Mass or lump in the belly
Fatigue
Unexplained weight loss
Fever
Swelling of ankles and legs
High blood pressure
For more information, visit the American Cancer Society at www.cancer.org or call them at 1-800-ACS-2345. It's called minimally invasive surgery, but G. Bino Rucker, MD, a board certified urologist at Manatee Memorial Hospital, says laparoscopy offers maximum benefits to patients needing surgery to treat urological disorders.
During laparoscopic surgery on the kidneys, Dr. Rucker says, he creates several small incisions in the abdominal area instead of one large one. He inserts a narrow scope with a tiny camera attached to it into one of the incisions. The camera provides images of the kidney area and magnifies them on a monitor that Dr. Rucker uses as a guide during the procedure. Dr. Rucker inserts surgical instruments through the other small incisions.
"Reduced blood loss from smaller incisions, better visualization for the surgeon during the procedure and shorter post-operative recovery -- that sums up laparoscopy," says Dr. Rucker. "When it is possible to operate laparoscopically, it's better for patients and surgeons."
Laparoscopic urology procedures performed at Manatee Memorial include:
Laparoscopic cyst removal, the removal of benign kidney cysts that cause pain and discomfort for the patient.
Laparoscopic partial nephrectomy, partial removal of a kidney if small lesions that may be cancerous are detected.
Laparoscopic radical nephrectomy, removal of one of the patient's two kidneys, usually because it is cancerous.
Laparoscopic adrenalectomy, performed when one of the patient's two adrenal glands is found to be cancerous.
Laparoscopic ureter repair, reconstructive surgery of the ureter, the urine tube attached to the kidney.
Laparoscopic kidney stone removal. Most kidney stones do not require surgical intervention, but large stones that impact the patient's urine flow may require removal.
G. Bino Rucker, MDManatee Urology, 2225 59th St. West, Suite D, Bradenton, FL 34209941-794-2464
Dr. Rucker notes that not every hospital has the equipment or staff to provide minimally invasive laparoscopic alternatives to traditional surgery.
"Manatee Memorial has both the up-to-date technology and the experienced team of professionals needed to perform this type of surgery," he says. "Patient outcomes are good and recovery time is reduced from six weeks to six days. It's a win-win situation for everyone."
206 Second Street East,Bradenton, FL 34208941-746-5111 FAX: 941-745-6862
Medical Executive Committee
Manatee WelcomesNew Physicians
The Lowdown on High Blood Pressure
New Therapy Helps Keep Coronary Arteries Open
Eat, Drink and Rehydrate
Small Incision Reaps Big Benefits
Sleep Apnea
Sounding Off About Coughs
Community Events
The ABCs of SARS
Past Issues
Small Incision Reaps Big BenefitsMinimally Invasive Surgery for Urology Procedures
On the LookoutAccording to the American Cancer Society,symptoms of kidney cancer include:
Blood in the urine
Low back pain (not from an injury)
Mass or lump in the belly
Fatigue
Unexplained weight loss
Fever
Swelling of ankles and legs
High blood pressure
For more information, visit the American Cancer Society at www.cancer.org or call them at 1-800-ACS-2345. It's called minimally invasive surgery, but G. Bino Rucker, MD, a board certified urologist at Manatee Memorial Hospital, says laparoscopy offers maximum benefits to patients needing surgery to treat urological disorders.
During laparoscopic surgery on the kidneys, Dr. Rucker says, he creates several small incisions in the abdominal area instead of one large one. He inserts a narrow scope with a tiny camera attached to it into one of the incisions. The camera provides images of the kidney area and magnifies them on a monitor that Dr. Rucker uses as a guide during the procedure. Dr. Rucker inserts surgical instruments through the other small incisions.
"Reduced blood loss from smaller incisions, better visualization for the surgeon during the procedure and shorter post-operative recovery -- that sums up laparoscopy," says Dr. Rucker. "When it is possible to operate laparoscopically, it's better for patients and surgeons."
Laparoscopic urology procedures performed at Manatee Memorial include:
Laparoscopic cyst removal, the removal of benign kidney cysts that cause pain and discomfort for the patient.
Laparoscopic partial nephrectomy, partial removal of a kidney if small lesions that may be cancerous are detected.
Laparoscopic radical nephrectomy, removal of one of the patient's two kidneys, usually because it is cancerous.
Laparoscopic adrenalectomy, performed when one of the patient's two adrenal glands is found to be cancerous.
Laparoscopic ureter repair, reconstructive surgery of the ureter, the urine tube attached to the kidney.
Laparoscopic kidney stone removal. Most kidney stones do not require surgical intervention, but large stones that impact the patient's urine flow may require removal.
G. Bino Rucker, MDManatee Urology, 2225 59th St. West, Suite D, Bradenton, FL 34209941-794-2464
Dr. Rucker notes that not every hospital has the equipment or staff to provide minimally invasive laparoscopic alternatives to traditional surgery.
"Manatee Memorial has both the up-to-date technology and the experienced team of professionals needed to perform this type of surgery," he says. "Patient outcomes are good and recovery time is reduced from six weeks to six days. It's a win-win situation for everyone."
206 Second Street East,Bradenton, FL 34208941-746-5111 FAX: 941-745-6862
Greenlight Laser for BPH
This was my first advertisement for green light laser pvp of prostate gland. I have performed 100''s of these cases at this point in time and can advise on the finer points of decision making. More information to follow on these patients.
gbr
Laser Procedure for Enlarged Prostate Gets Green Light at Manatee Memorial Hospital
In the traditional procedure to correct benign prostatic hyperplasia (BPH), called transurethral resection of the prostate (TURP), surgeons perform an open procedure that can carry risks such as blood loss and complications with anesthesia. It also requires a two- to three-day hospital stay, and many patients need a catheter when they leave the hospital. The GreenLight PVPTM Laser Procedure offers patients an effective treatment option for BPH that can reduce the complications or inconveniences that may be experienced with traditional surgery. Manatee Memorial Hospital is the first hospital in Bradenton to offer advanced laser technology for the treatment of BPH.
G. Bino Rucker, MD Manatee Urology 4705 26th St. West Suite B Bradenton, FL 34207 941-752-1553
Urologist G. Bino Rucker, MD, was the first surgeon to use the GreenLight PVP Laser at Manatee Memorial Hospital. "When I compare GreenLight to the traditional surgery for BPH, I tell a patient: 'I can do this new procedure and you will have less blood loss. You'll do it as an outpatient, and I'll take out the catheter in the recovery room.' We now have an option that is 10 times better than what we had. That's what this procedure is all about," he says. During the surgery, a thin instrument called a cystoscope is inserted into the bladder and prostate. A thin fiber is threaded through the scope to transfer laser energy that vaporizes the enlarged prostate tissue. There is no incision so there is no worry about blood loss. (There is also no need for patients to temporarily stop any blood-thinning medications they may be taking.) Patients can return home the day of surgery and resume normal activity within a week. Like TURP, the procedure does not affect sexual function.
Most patients with enlarged prostates are candidates for the GreenLight PVP Laser Procedure. However, some patients may be restricted. "This technique can't be used if the prostate is too large, too infected or if cancer is present," Dr. Rucker says. Dr. Rucker was involved in bringing this technology to Manatee Memorial, recognizing the unprecedented benefits that would become available to his BPH patients. "My whole focus in the community is to keep the hospital on the cutting edge," he says. "Our theme is to do things in a minimally invasive manner. That's the road that should be followed in healthcare. That's good for patients because it means less inconvenience for them." To schedule an appointment with Dr. Rucker, please call 941-752-1553.
206 Second Street East,Bradenton, FL 34208941-746-5111 FAX: 941-745-6862
Laser Procedure for Enlarged Prostate Gets Green Light at Manatee Memorial Hospital
In the traditional procedure to correct benign prostatic hyperplasia (BPH), called transurethral resection of the prostate (TURP), surgeons perform an open procedure that can carry risks such as blood loss and complications with anesthesia. It also requires a two- to three-day hospital stay, and many patients need a catheter when they leave the hospital. The GreenLight PVPTM Laser Procedure offers patients an effective treatment option for BPH that can reduce the complications or inconveniences that may be experienced with traditional surgery. Manatee Memorial Hospital is the first hospital in Bradenton to offer advanced laser technology for the treatment of BPH.
G. Bino Rucker, MD Manatee Urology 4705 26th St. West Suite B Bradenton, FL 34207 941-752-1553
Urologist G. Bino Rucker, MD, was the first surgeon to use the GreenLight PVP Laser at Manatee Memorial Hospital. "When I compare GreenLight to the traditional surgery for BPH, I tell a patient: 'I can do this new procedure and you will have less blood loss. You'll do it as an outpatient, and I'll take out the catheter in the recovery room.' We now have an option that is 10 times better than what we had. That's what this procedure is all about," he says. During the surgery, a thin instrument called a cystoscope is inserted into the bladder and prostate. A thin fiber is threaded through the scope to transfer laser energy that vaporizes the enlarged prostate tissue. There is no incision so there is no worry about blood loss. (There is also no need for patients to temporarily stop any blood-thinning medications they may be taking.) Patients can return home the day of surgery and resume normal activity within a week. Like TURP, the procedure does not affect sexual function.
Most patients with enlarged prostates are candidates for the GreenLight PVP Laser Procedure. However, some patients may be restricted. "This technique can't be used if the prostate is too large, too infected or if cancer is present," Dr. Rucker says. Dr. Rucker was involved in bringing this technology to Manatee Memorial, recognizing the unprecedented benefits that would become available to his BPH patients. "My whole focus in the community is to keep the hospital on the cutting edge," he says. "Our theme is to do things in a minimally invasive manner. That's the road that should be followed in healthcare. That's good for patients because it means less inconvenience for them." To schedule an appointment with Dr. Rucker, please call 941-752-1553.
206 Second Street East,Bradenton, FL 34208941-746-5111 FAX: 941-745-6862
Wednesday, February 27, 2008
Teaching points from Art's case
Case 1, ART
Here are some conclusions that one can make from Art's case.
a. He made a mistake trying an experimental treatment originally at Georgetown. Experimental treatments can get you into a heap of trouble quickly.
b. His biggest mistake was ludicrous and unfortunately, his physician is at fault. It is insane to place radioactive seeds into this poor man's prostate after the number of treatments he already underwent. This poor guy developped true "rocks with spicules" in his prostate. He was bleeding, breaking catheter balloons, and draining urine from his leg! It was a remarkeable case of how badly physicians can harm there patients. I know who treated the patient. The treatment team has a world class reputation.
c. World class reputation. This reminds me of what my favorite surgery professor used to say: IT doesnt take a brain surgeon to be a neurosurgeon. What I am conveying to you is: Dont always believe the marketing hype. Ask questions from trusted sources; seek multiple opinions when you are uncertain.
final point: The biggest mistake I see in the realm of prostate cancer is overtreatment and overdiagnosis by patients and physicians alike. Patients lose sight of the fact that doctors can make big bucks treating prostate cancer. Caveat Emptor!
Here are some conclusions that one can make from Art's case.
a. He made a mistake trying an experimental treatment originally at Georgetown. Experimental treatments can get you into a heap of trouble quickly.
b. His biggest mistake was ludicrous and unfortunately, his physician is at fault. It is insane to place radioactive seeds into this poor man's prostate after the number of treatments he already underwent. This poor guy developped true "rocks with spicules" in his prostate. He was bleeding, breaking catheter balloons, and draining urine from his leg! It was a remarkeable case of how badly physicians can harm there patients. I know who treated the patient. The treatment team has a world class reputation.
c. World class reputation. This reminds me of what my favorite surgery professor used to say: IT doesnt take a brain surgeon to be a neurosurgeon. What I am conveying to you is: Dont always believe the marketing hype. Ask questions from trusted sources; seek multiple opinions when you are uncertain.
final point: The biggest mistake I see in the realm of prostate cancer is overtreatment and overdiagnosis by patients and physicians alike. Patients lose sight of the fact that doctors can make big bucks treating prostate cancer. Caveat Emptor!
Case 1
My first patient I would like to describe in story form is patient Art. The name has been changed, but Art comes to me at age 63 years old with a history of prostate cancer. He comes to me with a suprapubic tube in place for one year. This is a tube which traverses the abdomen into the bladder directly.
It was placed due to severe bleeding episodes after treatment for prostate cancer. His psa is now zero; he is essentially cured of prostate cancer upon seeing me.
His history of prostate treatments involved a failed experimental treatment at georgetown followed by a round of radiation treatments also at georgetown, I believe. Subsequently, he underwent seed placement. None of this would I have recommended to him, but I only saw him after the initial insults.
Yes, he is cured, but his bleeding became very profuse. To make matters worse, he developped a fistula between his upper thigh and his bladder. Yes folks, the poor man was dripping urine from his leg on a constant basis!
He ultimately had to have his bladder removed and his ureters placed onto his abdominal wall draining into a bag. His prostate cancer is cured, but his life is miserable.
He is a kind gentle man; one of my favorite and most grateful patients. I dont wish his story or treating physicians upon anyone.
gbr
It was placed due to severe bleeding episodes after treatment for prostate cancer. His psa is now zero; he is essentially cured of prostate cancer upon seeing me.
His history of prostate treatments involved a failed experimental treatment at georgetown followed by a round of radiation treatments also at georgetown, I believe. Subsequently, he underwent seed placement. None of this would I have recommended to him, but I only saw him after the initial insults.
Yes, he is cured, but his bleeding became very profuse. To make matters worse, he developped a fistula between his upper thigh and his bladder. Yes folks, the poor man was dripping urine from his leg on a constant basis!
He ultimately had to have his bladder removed and his ureters placed onto his abdominal wall draining into a bag. His prostate cancer is cured, but his life is miserable.
He is a kind gentle man; one of my favorite and most grateful patients. I dont wish his story or treating physicians upon anyone.
gbr
Purpose of this blog
Hi,
I am a board certified urologist. My practice website is www.urology-partners.com. There you can check up on me and read about me. I am going to share some case histories of actual patients of mine in order to teach the public and my patients about prostate cancer.
I am not shooting for exquisite grammar skills, so pardon any typo's that may exist. Without further adieu, I move to my first case. I will follow each case with my critical analysis.
GBR
I am a board certified urologist. My practice website is www.urology-partners.com. There you can check up on me and read about me. I am going to share some case histories of actual patients of mine in order to teach the public and my patients about prostate cancer.
I am not shooting for exquisite grammar skills, so pardon any typo's that may exist. Without further adieu, I move to my first case. I will follow each case with my critical analysis.
GBR
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