Molecular Imaging Lab Silby:
I'm Howard Silby.
I'm 75 years old.
I live here in the area.
In the last 13 years I've lost
seven and a half organs
to six surgeries all done here
at the NIH.
Two and a half years ago,
I was diagnosed
with prostate cancer.
That's one of those seven
and a half organs
that I've lost.
Knowing with my family history,
my father dying of the disease,
um, I've kind of been
on the watch out for it.
I've had a bunch of biopsies,
a bunch of MRIs.
Finally two
and a half years ago,
on about the sixth
or seventh biopsy
in this special program
that they're doing here-with the
high field strength MRI,
the three tesla machine,
along with ultrasound
and merging those images-they
found a little spot,
biopsied that, it was positive.
Choyke: The whole point
of this is to try
to develop better ways
of diagnosing prostate cancer
earlier and more accurately,
eventually to do away
with surgery altogether
and simply do minimally invasive
techniques for treating it.
So this is a multistep process.
That involves doing endorectal
coil MRI scans.
It comes out very similar
to this.
And when we look
at it using the multiparameters
that we obtained with the MRI,
we're able to assign
probabilities,
based on the imaging,
that the man actually has a
cancer and the risk
that it's a high-grade
or aggressive cancer.
The two modalities
that we use are the MRI
and PET scan.
We can begin to put together
with PET scanning a metabolic
picture or a molecular picture
of what's going
on inside a cancer cell.
So when you combine the
functional kind of information,
molecular information
that we get with PET scanning,
with the anatomic information
that we get
with MRI that's a very powerful
fusion of information.
In fact, literally we fuse the
one image to the other image.
The patient then goes
to a separate room
in the hospital,
where there's an ultrasound
device, and we register this MRI
information to the ultrasound.
So that the man then gets a
biopsy of his prostate using
ultrasound,
which has the desirable features
of being real time and so
that you can watch the progress
of the needle very accurately.
The imaging provides the roadmap
for that.
It tells the physician
where to biopsy, what to biopsy,
and so that's why it's
critically important.
Silby: You know,
if you go to your regular
urologist and they do an
ultrasound and they see
something a little funny,
ordinarily, they just,
they shoot a bunch
of needles in there.
They're kind of going blind.
They're just taking 8, 12, 10,
12 cords, boom, boom.
They kind of sticking the area
where they see it,
but it's not specific.
And the thing
about the study here is they see
specifically,
exactly where to go.
Choyke: So the MRI
and the PET scan adds a lot
of information to what he knows.
And so more accurate knowledge
will make patients have better
information
and make better informed
decisions about what kind
of treatments they should have.
Silby: I mean, this is a really,
really tough decision.
What do you do?
Because there are all these
options, and there's no evidence
that one is really better
than the other.
They laid out all the options
for me: nothing, do nothing,
do radiation, do surgery.
And I thought about it,
and got a lot of consultations
and a lot of thinking
and talking it
over with my family,
and my wife, and my kids,
and so forth.
And I chose,
I decided on the route
of surgery.
Cause the radiation
and the surgery both have the
same side effects.
You can still become
incontinent,
and you can still lose your
sexual function.
[My] urinary function is
as close to 100 percent
as you can get.
Sexual function, I'm 75,
it's not so great,
but it's satisfying.
I'm happy.
I'm not depressed.
It's enough.
It's enough
that I feel comfortable,
and that's a small price to pay
for knowing
that I'm still alive.
