Dr. Peter Albertsen

Better Urologic Cancer Detection

Dr. Ben Ristau uses ultrasound to guide a transperineal prostate biopsy.

Dr. Ben Ristau uses ultrasound to guide a transperineal prostate biopsy.


UConn Health urologists are at the forefront of new and improved approaches to detecting prostate and bladder cancer, the first and fourth most common forms of cancer among men.

When a patient needs a prostate biopsy, the urology team is among the first in New England to practice a new method called transperineal prostate biopsy, which offers distinct advantages in safety and precision over previous protocols.

Historically when a biopsy was needed, urologists would pierce the rectal wall with a needle to take a biopsy of the prostate. Known as a transrectal biopsy, the procedure carries a small but real risk of infection. Roughly three out of every 100 men who undergo a transrectal biopsy end up in the intensive care unit with sepsis, a potentially life-threatening condition related to the body’s response to infection.

“The other problem with the transrectal approach is the difficulty accessing some portions of the prostate,” says Dr. Peter Albertsen, chief of UConn Health’s Division of Urology. “The angle of the biopsy needle traversing the probe makes it hard to hit the apex of the prostate. With the transperineal approach, we are finding it much easier to access regions of the prostate which historically have been difficult to reach with a transrectal probe.”

With transperineal biopsy, the needle that retrieves the tissue sample goes not through the rectum but the soft tissue just outside and past it, guided by the latest ultrasound technology for a clear, real-time view.

“Fortunately there are no nasty blood vessels, there are no nasty nerves, and it’s a straight shot to get” to the prostate, Albertsen says. “And by not going through the rectum, we anticipate the risk of sepsis going to zero.”

For bladder cancer detection, the urologists are the first in central Connecticut to use a new blue light cystoscopy technology to illuminate tumors in the bladder and identify smaller cancers earlier than ever before.

Certain tumors are hard to detect using traditional white light cystoscopy, but turn pink under the enhanced imaging provided by the blue light.

“Recurrence rates for bladder cancers are somewhere in the 50–70% range. Using blue light cystoscopy, depending on the tumor type, can reduce the risk of recurrence by about 40%, which means fewer trips to the operating room,” says Dr. Benjamin Ristau, UConn Health’s surgical director of urologic oncology.

The Power of MRI

A UConn Health physician is seen reviewing an MRI brain scan.

A UConn Health physician is seen reviewing an MRI brain scan. At UConn Health, doctors are pioneering ways to use MRI technology to diagnose and monitor a range of conditions affecting many parts of the body Photo: Peter Morenus


Magnetic resonance imaging (MRI) has come a long way since the technique was first used in the U.S. in the late 1970s. UConn Health is now taking this powerful, non-invasive imaging tool to the next level.

UConn Health physicians in a variety of specialties are using the technology — which captures images of the inside of the body using a large magnet rather than radiation — in new ways to detect and monitor illnesses.

Prostate Cancer

Dr. Peter Albertsen, chief of UConn Health’s Division of Urology, currently follows 100 patients with localized prostate cancer, which is slow-growing, using advanced multiple-parametric MRI imaging. The technology has now replaced ultrasound as the imaging method of choice for prostate cancer. The technique yields multiple imaging sequences of the prostate, providing information about the anatomy, cellular density measurement, and vascular supply.

There is growing evidence to support the idea that the best treatment plan for low-grade prostate cancer is “watchful waiting” to monitor its progression, instead of immediate surgery or radiation. Albertsen’s practice of active surveillance, and not intervention, for localized prostate cancer was reinforced by a recent long-term study published in September in the New England Journal of Medicine, on which Albertsen served as a consultant.

The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection.

Liver Disease

UConn Health is the first in Greater Hartford to use MRI to measure the stiffness of patients’ livers to reveal disease without the need for biopsy. Its MR elastography technique involves placing a paddle on a patient’s skin over the liver during MRI to create vibrations and measure the velocity of the radio waves penetrating the organ. This can indicate a stiffer liver and help diagnose fibrosis, cirrhosis, a fatty liver, or inflammation associated with hepatitis. The initiative is led by Dr. Marco Molina, radiologist in the Department of Diagnostic Imaging and Therapeutics.

“The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection,” Molina says. “Plus, with the obesity epidemic, patients developing nonalcoholic steatohepatitis (NASH), or fatty liver, can receive earlier diagnosis and take action to reverse their disease’s progression with diet and exercise.”

Breast Cancer

The new Women’s Center at UConn Health has opened its state-of-the-art Beekley Imaging Center, featuring advanced breast cancer screening. Dr. Alex Merkulov, associate professor of radiology and section head of women’s imaging, and his team are conducting research to test the effectiveness of using an abbreviated, five-minute MRI scan to confirm or rule out a breast cancer diagnosis. Typically, an MRI test takes 20 minutes, but researchers are seeing that a briefer MRI scan of just a few minutes can help provide a definitive answer to whether an abnormal breast growth is cancer or not — and potentially help women avoid the biopsy process.

Arthritis

The UConn Musculoskeletal Institute is now researching the use of MRI to assess and map the strength, weakness, and underlying makeup of a patient’s cartilage, especially for those with arthritis. The tool can allow orthopedic experts to identify any thinning or loss of cartilage in the body, which signifies moderate to late-stage disease. In early stages of arthritis, MRI can help pinpoint early morphological and subtle biochemical changes in cartilage.

Neurological Disorders

In neuroradiology, UConn Health is using the power of MRI to differentiate brain tumors, to detect strokes, to assess dementia, to diagnose multiple sclerosis, to evaluate traumatic brain injury, to find the source of epilepsy, and to guide brain surgery. In March 2017, leading neuroradiologist Dr. Leo Wolansky joins UConn Health to advance its research and chair the Department of Diagnostic Imaging and Therapeutics. Wolansky’s neuroimaging research has focused on enhancing understanding of MRI and its contrast agents, especially for multiple sclerosis and brain tumors. He also specializes in the hybrid imaging modality PET-MRI.

“Thanks to the power and advancement of MRI, doctors can see early evidence of disease and seize the opportunity to intervene and improve their patients’ health,” Molina says.