The concept of fast-growing cancers called “interval cancers” has led to routine biannual screening of male and female high-risk patients. It is recognized that mammography misses invasive breast cancers with great frequency, so there is a half-year time period in which health-conscious women should alert themselves to the possibility of early breast cancer as they routinely undergo ultrasound breast screening twice a year. In practice, about 5 % of men develop aggressive interval cancers within half a year from their last normal or stable evaluation. A presentation entitled “Interval Cancers Of The Prostate: Evaluation By 3-T MRI And 3-D Power Doppler Ultrasound” was made at the 2011 meeting of the Societe Francaises de Radiologie in Paris, demonstrating that new aggressive tumors may occur more rapidly than clinically expected and may, in part, explain the failure of certain treatments (Bard 2011).

When a man has not had a biopsy or has had a negative biopsy and a vascular tumor is demonstrated on the 3-D PDS, an MRI exam is recommended, which shows the prostate gland, the capsule of the prostate, the regional lymph glands, seminal vesicles, and boney pelvis. Other bones, to which cancer frequently spreads such as the lower spine and hip, may also be imaged for abnormalities. While the MRI exam is not as good an indicator of cancer aggression, it shows spread of the tumor outside the prostate capsule to the lymph nodes better than the 3-D PDS and better than the CT scan, which is currently used as the standard test for staging.

The value of medical imaging is to:

One of the problems of evaluating cancer treatment is that the tumor may be rendered harmless or even dead but the volume of the tumor remains the same or even enlarges. That is, the cancer cells may be killed off and scar tissue replaces the dead cells, leaving the size of the original malignancy unchanged, or edema and necrotic fluid buildup enlarges the region, simulating tumor growth. This lesson was learned 19 years ago in treating liver tumors. The therapy would render the cancer harmless, but the size of the mass on the isotope scans, sonogram, CT, and MRI would remain unchanged or even enlarge. The same is true of some prostate cancers that are inactivated but still feel like cancer on the digital rectal exam and show a mass effect on the sonogram and MRI. There needs to be a way to monitor changes and determine the efficacy of treatment. Fortunately, the blood flows in malignancies that have been inactivated decrease or disappear and can be quickly and accurately measured in the moment. Thus, with 3-D PDS, there is a simple tool to quantify blood flow patterns to demonstrate therapeutic response.

Testosterone has not been implicated as the cause of prostate cancer. Environmental and dietary factors are likely major contributors of the development of aggressive, invasive cancers. Despite these factors, androgens—testosterone and DHT—are thought to be the major source of PCA growth. Yet androgen ablation therapy, ABT, is a failed approach in many cases. Over time, most prostate cancer cell lines become more and more resistant to androgen receptor activities or growth suppression due to the development of androgen resistant cell lines. Initial suppression by ABT is frequently followed by rapid progression of poorly differentiated, hormone-independent cell lines within 12–36 months. Newer approaches have aimed at increasing the antiandrogen blockade. However, since androgens have significant systemic benefits, this treatment approach can have serious progressive adverse effects and QOL decrements. These antiandrogen approaches or adjunctive chemotherapy may extend the remission temporarily, but all these options have highly significant adverse effects associated with prolonged use and few individuals are able to achieve full remissions. Those cases that seem to achieve stable “remissions” have low-grade cell types that might do better with intermittent hormone blockade or alternative approaches. The primary focus on the role of androgens in the growth, progression, and suppression of PCA cell lines has limited the development of other potential endocrine approaches. Still there are no good options available when ABT failures occur.