CDU & New Guys

Any new guys......... If you need a biopsy make sure its color doppler guided,by one the experts.........Cooper

I don't know  Dr. Samadi ! But I do know Dr Fred Lee in Mi........& you obviously do not know me.........Cooper 

My husband was one of the 2%.........if you can get one do so......why not its added assurance that the biopsy is targeting the right area. My husband was lucky to have Dr Lee right in our own back yard [Mi]..........Cooper 

Function
The Color Doppler Ultrasound measures blood flow to the area and displays the results in full color for interpretation by your radiologist and oncologist.

Effects
Using the images gathered by the Color Doppler Ultrasound, your doctors have the ability to identify tumors on your prostate. The results also give information about the size, type and stage of the cancer.

Benefits
Color Doppler Ultrasounds are quick and cause no pain, compared to needle biopsies. These ultrasounds also pose no threat for inflammation that may exacerbate tumors in some cases.

Considerations
Although Color Doppler Ultrasound is effective in the majority of cases, it is possible for tumors of the prostate to not show up with the test. For example, a study by EJ Halpern at Thomas Jefferson University revealed that as many as 20 percent of Color Doppler Ultrasounds miss the presence of cancerous prostate tumors in patients.

 http://www.ehow.com/facts_5505755_color-ultrasound-test-prostate-cancer.html#ixzz1H7jFp9QO

 

"The CDU is not perfect and does miss small but significant tumours."                                       

I believe from what I have read that in the right hands CDU does maybe sometimes miss small but INSIGNIFICANT tumors........... and in the case of Pca is a good thing Because after 50-60 most men have some degree of prostate cancer whether it be atypical cells or indolent cancer.........

I guess I just believe CDU is another tool in the toolbox when dealing with a elevated psa.........I do know that JohnT says it helped to find a tumor after many biopsies did not, that and all the research I did on CDU and Dr Lee told me it was the right thing to add to our investigation as to why my husbands psa was elevated...............

prostatitus can skew psa and fpsa and even after a course of antibiotics to rule out infection, a biopsy can make a mess of the psa number and flare up the prostatitus.........We're comfortable with Dr Lees assessment of my husbands situation..........I only post about CDU because from experiencing seeing it I believe it is an important tool.............Cooper

Well maybe for the guys in the states where they are more readily available [done by expert]MI,CA,FL are the ones I know of. I guess I'm going by experience it seemed easy for us being in mi,I called for an appointment and a week and half later we were seeing Dr Lee,I know our circumstances made it easier but we would have traveled if necessary...........I guess its not odd to push it for the people in the areas where they are available.........BCBS covered both scans,it didn't seem out of reach...... Hope things will get better & better for you [I know you have been having issues] Purgatory....................................Cooper

Fairwind, tend to agree with what you just said.

The 2 largest and oldest urological practices combined in my area 3 years ago, and have formed the largest in the entire state. They triy to stay, "state of the art", and like you said, if it were that definitively useful and accurate, I would think a huge practice like this would easily purchase and use one.

My own uro, whom I trust greatly, feels that they are not accurate enough to be useful, at least not to have across the board.

Probably get slammed by the "experts" for saying that, but don't shoot the messenger.

david

Fairwind and David,
I have posted many times why CDU is not commonly used.
1. It is done by interventional radiologists who are trained in reading scans.
2. Urologist are very protective of the biopsy domain and will never refer anyone to a radiologist for a biopsy. There have been numerous attempts to integrate MRIs and other scan do do more accurate real time biopsies and all have met stiff resistance from the urological community. Dr Scholz uses a CDU, but won't do biopsies because of this.
3. The Equipment cost $125k to 150k and you have to do a lot of biopsies to make it up. Medicare doesn't pay anymore for a CDU than it does for an ultrasound.
4. It takes a lot of training and pactice to read the scans. To most doctors doing only a few biopsies a week it doesn't make sense.
5. The major institutions don't use it because the radiology teachers and students are into newer technology and just don't want to learn a technology that is 20 years old.
As far as I know only 6 interventional radiologists and one oncologist uses CDU. I don't know any urologist that does. There could be more that use it, but I don't know of them. Drs Bard and Sconti in NY, Dattoli in Fla. Fred Lee in MI and Duke Bahn, Doug Chen and Mark Scholz in ca. are the only ones I know.
JT

John, your 6 reasons are only further cementing why CDU isnt in much use. So the bottom line, it may be a good tool, but is in such limited use and availability, its not really part of most men's dx. process or decision.

Why should it be a matter for absolute belief? Do you know of any studies that directly test whether doppler or MRI scans are effective tools for determining who should not have surgery?

I'll direct this to any one of the "doctors" on here concerned that my husband is irresponsibly running 4 marathons last year, with undiagnosed Pca and that Dr Lee is not doing a biopsy [also irresponsible].........My husband had a full workup w/Dr Lee.prostate exam,CDU[said in pre paperwork be prepared to have a biopsy if necessary],course of antibiotics [which brought the psa down significantly] another CDU...as the irresponsible Dr Lee said.....after careful examination there were patches of prostatitus,calcification,saw no reason to do biopsy and also said do not let anyone biopsy you as we were leaving [as biopsy would flare up prostatitus].........even though most will insist [on this forum] that CDU has no value well.....I have a different opinion,backed with the experience of seeing it done by the master at it and I'm just as much a doctor as the rest of you LOL!!!!!!!!........... Cooper    Sorry for the sarcasm can't help it.Gotta go probably for good,I have a ton of patients to see.I'll leave the explaining of CDU to JohnT.............................. 

Postop,
You can start at Dr Barkin's website, pcrf.org and view the Dr Bahn video on CDU staging.
There are no studies on either MRIS or CDU in staging. How would you even set up a study as there are so many varibles on surgery. For years many of the top oncologists have referred their patient for these scans as part of the staging process. The location and volume of the tumor as well as extracapsular extensions have a direct correlation to the effectiveness of surgery. These are well known and anything that gives you more information about these, BEFORE treatment will aid in decision making. Large APEX tumors, Seminal vessicle involvement and extracapsular extensions all have a high probability for failing surgery, and both these scans are very good at identifying these. Yet doctors continue to refer low risk patients for ineffective CT and bone scans at 4X the cost. This doesn't make any sense.

John,

Thank you for your response. I guess the way to show that doppler could reduce the need for unnecessary surgery would be to take a group of preoperative patients where it is uncertain if the disease is outside the prostate. Do several types of imaging, MRI, doppler, bone scan, CT, etc on each patient. Compare the results, which ones show extraprostate extension, SV involvement, suspicious lymph nodes, bone mets--whatever that test can show that would lead you to believe that the disease has spread. See what the "extra yield" of doppler would be, that is, what portion of patients have spread documented on doppler where it wasn't evident from any other tests. I bet that many patients going to Dr. Lee have already had some of these other tests before coming to see him. It would be a simple case series, not a randomized clinical trial. Has a series like this been published? It would go a long way towards clarifying this issue, so that it wouldn't be a matter of opinion or advocacy, but of evidence. If the doppler users in practice have great results, they should want to prove it to the world with a peer reviewed article in the medical literature. Hopefully they have done this.