When I come home from the river the “back way” I always go by this spot and try to take a picture of this tree and the mountain behind it through the window of my van. This is Skitts Mountain and when I pass it going home it is almost always is illuminated by the setting sun. This interesting tree also is highlighted and each changes with the time of day and the season. I look forward to seeing how this scene will look on any given day.
I can’t show my pictures or videos of my ride home to my wife anymore…” John, did you take that while you were driving? Joooooohn. Did you?”
Dr. Cooner was from Mobile, Ala and was in the waning years of his career when the prostate ultrasound and PSA came about. Somehow he became the face of prostate ultrasound and prostate biopsies. Before this time we did biopsies using the finger as a guide. At first we thought that the majority of prostate cancers showed up on ultrasound as a dark spot. Then cancers returned where biopsies were done on the side opposite of the dark spot. (hypo echogenic) We then increased the number of biopsies we did from sextant (the six that Dr. Cooner alludes to) to the now most common technique of twelve.
I heard Dr. Cooner speak one time. He was a scholar and a gentleman and I remember him talking to anyone that had an interest in meeting him. He had a kinda Bear Bryant look as I remember. I liked him. He put on prostate ultrasound and biopsy talks all over the US.
He spoke of the diagnosis of prostate cancer as the “three-legged stool.” A stool won’t stand without the other legs. Let’s see:
- The PSA
- The Ultrasound and biopsy
- The Rectal exam
So…prostate cancer shows up on prostate ultrasound sometimes and sometimes it doesn’t. Sometimes it looks like it should be cancer and it is not, and sometimes it looks normal but it isn’t. The ultrasound now is used to systematically obtain samples in an organized fashion and it allows for smaller samples that promoted the outpatient method of prostate biopsies. The article you see is from around 1992, but he started all the fuss around 1988. I went to Houston to see Dr. Cooner’s talk and took the course.
So no, the ultrasound doesn’t always see the cancer and it is used to take samples in a systematic fashion.
It’s funny isn’t it….the more things change and the more they stay the same………
Prostate Diaries 
The three legged stool remains three legged.
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