Prostate Cancer Detection: International Expertise and Innovation at Assuta Ashdod

Prostate cancer is a global killer that takes the lives of approximately 350,000 men each year.

Among the most common types of cancers in men, nearly 3,000 Israelis are diagnosed with invasive prostate cancer each year, and 500 die. According to the World Health Organization, Israel ranks 58th in the world for the prevalence of prostate cancer but 143rd in the mortality rate.

Early detection of prostate cancer is critical since it enables treatment and paves the way for better patient outcomes. An experienced urologist is also indispensable, both for the diagnostic and treatment phases.

International training comes home

Dr. Orit Raz, one of Israel’s top urologists, is dedicated to early detection. A native of Talmey Yechiel, a small community near Ashdod, Dr. Raz completed her urology residency in Shamir Medical Center before embarking on a research fellowship in Toronto, Canada, and a clinical uro-oncology fellowship in Sydney, Australia. Her training in Australia included learning what was then a brand new detection technique called In-bore MRI guided Prostate Biopsy.

Always intending to return home to Israel to practice, Dr. Raz began her professional career as a senior urologist at Tel Hashomer Medical Center, where she conducted prostate, kidney and urinary bladder operations using the Da Vinci robotic system for a minimally invasive approach. In addition to utilizing traditional detection techniques, Dr. Raz introduced the staff to In-bore MRI guided prostate biopsies. In 2017, after recognizing the importance of this new life-saving identification method, Assuta Ashdod actively recruited Dr. Raz to head their urology department.

The evolution of diagnostic tools for prostate cancer detection

Twenty years ago, no imaging modality existed to help detect prostate cancer, putting patients in danger of reaching late and potentially untreatable stages of the disease… undetected. Urologists worldwide relied on a manual rectal examination and a blood test to determine PSA level, a good indicator of potential prostate cancer cells. Typically, a urologist would then perform a random biopsy, guessing at the location of cancer to test cells without the support of guided imagery.

The prostate was the only organ in the body for which random biopsies were used to diagnose cancer.

But the random biopsy - the only detection method at the time - was not entirely accurate because there was no guarantee that the biopsy needle would catch the cancer cells, leading to false-negative results.

In the last two decades, Prostate-MRIs became available, and for the first time, professionals are able to see lesions suspicious for prostate cancer. This allowed for more accurate biopsy techniques, guiding a needle to a specific lesion within the prostate, and increasing the chances of correct early detection.

Today, given that we have guided imaging technology, there are three biopsy techniques to sample a lesion within the prostate. The first technique uses an ultrasound to cognitively guide the needle to the lesion. The second biopsy option is conducted while the patient lies in the MRI machine, allowing the urologist to see the lesion and aim the biopsy needle at the lesion in real time.

The third technique is prostate fusion biopsy that overlaps magnetic resonance images (MRI) with ultrasound images to produce a 3D hologram of the lesion within the prostate.

As head of the urology department in Assuta Ashdod, Dr. Raz performs all types of prostate biopsies and treatments, including In-bore MRI guided Prostate Biopsies, giving her the ability to customize the proper diagnosis and treatment for patients in every stage of the disease.

“Fusion and In-bore MRI guided biopsies are important because they are accurate and lead to better diagnoses,” says Dr. Raz. “However, this biopsy technique requires a prior MRI scan, as well as a specialized machine, so it is a more expensive and time-consuming procedure.”

Dr. Raz sees hundreds of prostate patients each year, mostly older men for whom the disease is more prevalent. She says that Assuta Ashdod has given her the ability to treat patients with the most appropriate methods available.

“In general, keeping down costs at public hospitals is a big priority, so there are limitations. But I don’t feel that here,” Dr. Raz says, satisfied with her ability to treat her patients holistically.

New is not necessarily better

Despite her extensive international training, Dr. Raz believes that traditional methods are still effective, and in some cases even preferable to more advanced procedures. She recently co-authored a research paper on the subject called “Finger Guided Biopsy in the Era of MRI Guided Prostate Biopsies,” which she has presented at a number of conferences.

“There is no one best method to perform a biopsy,” Dr. Raz comments. “Each patient has different parameters and I consider them all in order to make a quick and accurate diagnosis. The most important factor is early detection.” Dr. Raz speaks with authority as she is the only urologist in Israel to perform all techniques of prostate biopsies.

She believes that prostate MRI scans should be used regularly for prostate cancer screening.

“The advances in prostate detection and treatment are coming very fast,” she says. “And I feel fortunate to be able to help so many patients with all the tools available. That's why I’m at Assuta Ashdod.”