Beating Cancer Ahead Of Time

Given that Healthspan is a primary concern of my medical practice, it's not a surprise to any of my patients that I place a huge emphasis on early cancer detection, given how challenging it can be to combat late stage cancer, and given the fact and almost 1 in 2 men will acquire some form of cancer in their lifetimes.

Just a quick remedial note for first time readers: Healthspan constitutes the measurable quality of wellness and performance at any age, defined as the average number of years that a person can expect to live in maximal health, excluding the years lived in a less than healthy state, due to disease and injury.

So, what does early cancer detection look like?  Well, there are any number of screening tests out there to select from, but I will cover here a small inventory of extremely powerful tests, which can offer tremendous insight into disease state, should any be present.

Multiparametric MRI

Magnetic Resonance Imaging Has been around for many years, and has been used to detect Glioblastoma (brain cancer), among other forms of cancer.

However, in recent years, Multiparametric MRI has dramatically increased the sensitivity and resolution of imaging, and in particular, can be a powerful, non-invasive method of detecting very early prostate cancer, obviating the uncertainty of PSA (Prostate Specific Antigen blood test), or the invasive nature of obtaining a Gleason Score (tissue biopsy).

Multiparametric MRI can be understood to be a method of obtaining an information rich, three-dimensional image of the prostate, by combining T2-weighted, diffusion weighted, dynamic contrast enhanced, and in some instances, magnetic resonance spectroscopy images, into a unified picture of disease.

Advantageously, Multiparametric MRI can detect very small (well less than 1cm) lesions in the prostate region, and offer insight as to their characteristics, and if in fact they might be malignant or benign.  Additionally, these images can be used as a baseline for comparison later on, even if no disease is detected.

[To really dig into the particulars on MP MRI, this study offers further insight: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309696/]

Time Of Flight PET/CT

Like MRI, PET/CT (Positron Emission Tomography and Computerized Tomography) has been around a long time- however, TOF PET/CT, like Multiparametric MRI, has dramatically increased both the sensitivity and resolution of cancer imaging.

Interestingly, what 'Time Of Flight' refers to is the measurement of time taken by a particle or wave to traverse a given distance.  This information can be used by imaging software to produce super high resolution images of cancer.

In addition, because a radiotracer is used (Fluorodeoxyglucose-18) in TOF PET/CT, one can achieve insight into the state of metabolism of a solid tumor, given that the PET component of the image exploits cancer's reliance on glucose (sugar) metabolism to produce a Standard Uptake Value which compares the concentration of FDG-18 in normal tissue (kidneys, bladder) to tumor tissue.

Again, like Multiparametric MRI, TOF PET/CT can detect sub 1cm lesions, offering insight into disease state, possibly even at Stage 0.

[To get an even better grasp on TOF PET/CT, check this out: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639717/]

Circulating Tumor Cells

Notably, there are now more than 50 active clinical and research based companies in the Liquid Biopsy space.  For those not familiar with Liquid Biopsy, these are blood based early cancer detection tests, which quantify the presence of RNA/DNA fragments, unique protein biomarkers, and cancerous cells in blood.

The advantage of looking at Circulating Tumor Cells is that one can detect the tissue of origin (ergo, what kind of cancer it is, say, lung or breast), and in addition, the number of CTCs in a given volume of blood, which offers insight into how that number of cancerous cells could correspond to disease progression.

Furthermore, one can run a CTC test to gain a better understanding as to how efficacious any given form of disease intervention may be working, and since CTC tests are just a simple blood draw, they can be conveniently run on a monthly basis.

[To get more familiar with the basics of CTC testing, go here: https://www.scirp.org/html/1-8902151_57781.htm]

The Details Matter

So, these powerful testing modalities are all about getting the jump on cancer, hopefully detecting it at Stage Zero, well below the threshold of traditional clinical presentation of disease, all pursuant to defeating cancer before it gets a foothold.

At the same time it should be noted that the use of these tests in the manner described above does fall outside the Standard Of Care in mainstream Oncology, and this approach is not typically covered by insurance, so there is a financial component here that must be acknowledged.

That said, it is through these types of tests we can get a profoundly helpful understanding of disease at its earliest stages, something that goes a long way towards optimizing Healthspan.