UroLift can be a good option for patients who are frustrated with urinary symptoms they experience with BPH, but what happens when a patient with UroLift is suspected to have prostate cancer? In the case of UroLift, the patient receives permanent implants. Can men with UroLift be tested for prostate cancer with the same techniques as men who have not had the procedure?
E. David Crawford, MD asked expert Steven N. Gange, MD, FACS more about UroLift’s impact on patients.
E. David Crawford, MD
Steven N. Gange, MD, FACS
Question by E. David Crawford, MD:
UroLift is a system used to treat benign prostatic hyperplasia (BPH) that offers an alternative to invasive surgery or drug treatments. I recently saw a patient who had a rising PSA and prior negative biopsy before his UroLift. I am considering a mpMRI and am wondering what effect the procedure might have on performance and interpretation of the MRI?
Answer by Steven N. Gange, MD, FACS:
Yes, he can have the MRI, 3TMRI has no impact on the implants.
Question by E. David Crawford, MD:
Ok, now that I know you can have the MRI, are the implants close enough to the prostate to disrupt the MRI image?
Answer by Steven N. Gange, MD, FACS:
The nitinol capsular tabs of UroLift are not perceived by MRI. However, the stainless urethral end pieces are and create a small “lucent halo” in the immediate vicinity. Fortunately, this does not cause scatter or shadowing in the MRI. So, because peri-urethral prostate cancer isn’t at all common, the artifact is pretty meaningless.
There is also unpublished work from Stanford where the MRI “spin” is adjusted in a manner that the halo disappears.
ABOUT THE AUTHOR
Steven N. Gange, MD, FACS, graduated from the University of California Los Angeles School of Medicine in 1986 and then completed his urology training at the University of Kentucky in 1991. He served in the US Army from 1991-1996 as a teaching urologist, fulfilling an ROTC obligation. In 1996, he joined Western Urological Clinic in Salt Lake City, now Granger Medical Clinic/Summit Urology Group, where he is currently Director of Research and Education. Through ongoing investigation and clinical work, he has developed particular expertise in the field of men’s health urology, emphasizing minimally-invasive procedures for BPH and prostate cancer. As a clinical investigator, he was the first urologist in North America to perform UroLift for BPH, and first in the world to perform UroLift in-office under local anesthesia. Since FDA approval, he has successfully performed over 600 UroLift in-office procedures, using his refined local anesthetic technique, and he has taught UroLift to hundreds of fellow urologists across the US and Canada. He has also lectured on BPH and UroLift at numerous meetings and has co-authored 9 of the pivotal UroLift papers, including a review paper on emerging BPH technologies. In addition, he performed the first Rezum procedure in North America, and was lead enroller in NxThera’s RCT. Dr. Gange was also the first urologist in the Intermountain West to perform Sonablate HIFU for prostate cancer.
Dr. Gange is dedicated to educating the public in addition to medical providers. In 2001, he founded The Utah Healthy Living Foundation, a CME-accredited, non-profit, educational 501c3 corporation dedicated to improving the quality of life in Utah through health education and screenings, and he remains its president. He has held numerous other leadership positions, including President of the Utah Urological Society, Chair of the Utah Cancer Action Network, Chief of Surgery at St. Mark's Hospital, and a member of the Practice Management Committee for the AUA. He has been voted one of the Top Doctors in America by his peers. He regularly lectures to physicians and lay groups on various aspects of urology, and was instrumental in the creation of the urology section of WebMD.
