Schedule an appointment at ISMI for your prostate care needs. We offer prostate cancer risk assessment and liquid biopsy. There are many advantages to having your prostate procedures performed at ISMI:
· There is no wait time
· No referral is needed
· We bring you state-of-the-art technology
Prostate cancer is the most common cancer among Canadian men (excluding non-melanoma skin cancers). It is the third leading cause of death from cancer in men in Canada (1). Prostate cancer usually grows very slowly (low-grade) and may never cause any symptoms. Many men with prostate cancer will die of other causes rather than from prostate cancer.
However, some men will have aggressive (high-grade) prostate cancer that grows rapidly and can spread outside the prostate gland if untreated (2).
The most important question for men
Do I need a prostate biopsy?
The answer to this question has significantly changed in the past 10 years. At ISMI,our goal it make sure you do NOT get a needle inside your prostate UNLESS you absolutely need it for diagnosis and treatment.
High PSA = biopsy?… ABSOLUTELY NOT!
PSA is NOT an accurate test. In fact, most men with high PSA DO NOT have prostate cancer.
PSA can miss prostate cancer. in 1 in 7 men. 1 in 50 men with normal PSA may have a fast-growing, deadly cancer.
Relying on PSA for diagnosing prostate cancer is far from standard of practice.
Prostate biopsy may be fast and doable in an office, but it is not a harmless procedure.
Following a 2011 landmark study at Johns Hopkins (reference), one of the most important goals in prostate care has been to limit prostate biopsy ONLY to men who ABSOLUTELY need it.
“Coupled with appropriate screening, prostate biopsies save lives. However, it is important for men to be aware of the possible risks of prostate biopsies, which are often described as simple outpatient procedures.” says Dr Edward Schaeffer, M.D., Ph.D., a Johns Hopkins urologist and oncologist.
Even in countries such as Sweden, where state-of-the-art prostate care is widely practiced, 4% of biopsies result in hospitalization (reference).
Remember Sweden. Sweden is a very important country for prostate cancer. We will come back to Sweden when we introduce ISMI’s state-of-the-art liquid biopsy test.
Prostate care begins with EDUCATION
The journey starts with awareness and education. We have addressed the most important issues above. At ISMI, we emphasize the advice of American Cancer Society (ACS), Canadian Urological Association (CUA) and European Urological Societies (EAU-EANM-ESTRO-ESUR-ISUP-SIOG):
“Men should not be screened unless they have received information about uncertainties, risks and potential benefits of prostate cancer screening.”
At ISMI, Dr. Khashy can offer you his expertise in making sense of this information, that can be sometimes difficult to understand.
Prostate Cancer Risk Assessment
At ISMI, using a combination of patient characteristics and blood tests, we help you estimate your risk of low-grade (Gleason grade < 7) versus high-grade prostate cancer, followed by a discussion on advanced medical imaging options if you are at risk for or highly concerned about prostate cancer.
Prostate cancer is the most common cancer among Canadian men (excluding non-melanoma skin cancers). It is the third leading cause of death from cancer in men in Canada (1). Prostate cancer usually grows very slowly (low-grade) and may never cause any symptoms. Many men with prostate cancer will die of other causes rather than from prostate cancer. However, some men will have aggressive (high-grade) prostate cancer that grows rapidly and can spread outside the prostate gland if untreated (2).
What is Shared Decision Making?
Shared Decision Making is the cornerstone of our practice at ISMI.
At ISMI, our experts work with you to help you make decisions based on latest science (evidence-informed) AND in agreement with your preferences, values and risk attitudes (value-congruent) (reference).
This process is critical when there is a close trade-off between harms and benefits. Screening for many cancers, including prostate and breast cancer, are perfect candidates for shared decision making.
Dr Khashy strongly recommends reading the book “Your Medical Mind” to all his patients, especially to men who are concerned about prostate and breast cancer.
State-of-the-art prostate care in 2023
At ISMI, Dr. Khashy recommends the following for men who decide on further tests for prostate cancer:
Liquid biopsy is a medical technology breakthrough that allows detection of cancer footprints in the blood sometimes even before tumors can be detected with imaging.
Liquid biopsy is done with a blood test, like any other blood draw. It is less expensive than an MRI, and much more accessible.
Click here to learn about the differences between liquid and tissue biopsy.
If the result of the liquid biopsy warrant further investigation, we recommend a prostate MRI.
Prostate MRI is widely available in Quebec hospitals and clinics. We do NOT perform prostate MRI at ISMI.
If you have performed your prostate MRI already, Dr. Khashy will gladly review your MRI with you in the context of shared decision making. Dr. Khashy is among the first generation of radiologists who trained in prostate MRI at Harvard University with a team of leading radiologists and physicians, including the inventors of the prostate MRI coil. Dr. Khashy has read more than 5000 prostate MRIs todate.
It is important that your risk is recalculated after your MRI results. This steps is usually overlooked in prostate cancer care.
Stockholm3 is a blood test for early detection of aggressive prostate cancer. The test combines protein markers, genetic markers and clinical data in a proprietary algorithm for the purpose of detecting aggressive prostate cancer at an early stage. The result from Stockholm3 is a risk score that indicates the risk of aggressive prostate cancer and a recommendation that describes continued treatment.
A more precise test
Early detection is the key to successful treatment of prostate cancer. Today the blood test prostate-specific antigen (PSA) is used. One problem with PSA is that it misses between 30 and 50 percent of all aggressive cases of cancer. Research shows that Stockholm3 finds 100 percent more aggressive cases of cancer. This improves the ability to detect and treat cancer at an early stage.
Another problem with PSA is that it cannot distinguish between aggressive and benign cancer. Stockholm3 reduces the risk of conducting unnecessary prostate biopsies by 50 percent. As a result, many men do not have to undergo unnecessary follow-ups with a biopsy of the prostate, that can cause side effects such as
sepsis as well as blood in the urine and feces.
Healthcare providers in Sweden and Norway, who have replaced PSA with Stockholm3, show that direct care costs are reduced by 17 to 28 percent. This is because Stockholm3 reduces unnecessary and costly MRI’s, biopsies and treatments. Enables population-based screening Stockholm3 has been tested for general screening of prostate cancer. Stockholm3, in combination with MRI, reduces the number of unnecessary biopsies by 76 percent compared with PSA. In addition, the need for MRI is reduced by 60 percent and overdiagnosis is reduced by 39 percent. This makes the introduction of general screening of prostate cancer possible.
Stockholm3 has been developed by researchers at Karolinska Institute. In total, data from more than 75,000 men have been included in studies of Stockholm3. The results have been published in highly-ranked scientific journals such as The Lancet Oncology and European Urology. Stockholm3 has been available for clinical use since 2017. Several healthcare providers in Europe are now using Stockholm3. The company is ISO 13485 certified, and the software complies with IEC 62304 standard for medical technology software.
The result from Stockholm3 is a risk score that indicates the risk of aggressive prostate cancer, elevated risk, normal risk or low risk. Stockholm3 also provides clear treatment recommendations, which makes it easier for the treating doctor to make a decision on potential further actions. It also helps the man to get a better understanding of his individual risk of getting prostate cancer. With elevated risk, a referral to a urologist for further examination is recommended, and with low or normal risk, a new test within two to six years is recommended. Nearly half of the men aged 50 to 70 years have a low-risk profile and do not need to take a new test until after six years. The intended target group for Stockholm3 is men between the ages of 45 and 74.