Prostate cancer, or prostate carcinoma, is the most common cancer in men and the second leading cause of cancer-related deaths (source: DKG). In Germany, around 70,000 men are diagnosed with it every year. However, there is a very good chance of recovery if the disease is detected at an early stage, for example during preventive health screening (a medical check-up). In case of an early detection of prostate cancer several treatment options are available that will be tailored to your individual situation.
Prostate cancer causes no symptoms in the early stages.. Thisemphasizes the value of preventive health screening. An elevated serum level of Prostate-Specific Antigen (PSA) is a medical indication for further examination. An elevated PSA level indicates an alteration in the prostate such as an inflammation of the prostate, known as prostatitis. However, other conditions like prostate cancer may also be responsible. For this reason an elevated PSA level is an indication for further examination including for example ultrasonography, and magnetic resonance imaging (MRI) if applicable.
The likelihood of prostate disease increases with age. A screening examination is recommended from the age of 45 (from the age of 40 if there is a family history). The earlier the tumor is detected, the greater the recovery rate. If the tumor is limited to the prostate (organ-confined), with an appropriate therapy the recovery rate is approximately 95%. Prostate cancer screening is usually performed by urologists or by family doctors. It implies the determination oft he PSA level in the blood and if necessary further medical examination such as a transrectal ultrasound scan or palpation oft he prostate.
In principle, certainty about the diagnosis of prostate cancer is obtained by tissue sampling. Therefore, if abnormal conditions are found during screening, the German guideline currently recommends an ultrasound-guided transrectal biopsy of the prostate. Since the carcinoma detection rate for this procedure is only 20 to 30% repeated biopsies may be necessary which extends the period of uncertainty until a final diagnosis for the patient.
In contrast to other imaging techniques, multiparametric magnetic resonance imaging (mpMRI) of the prostate is a technique that combines several image parameters to assess the organ in detail. This radiation-free examination method usually enables reliably detection of aggressive tumor foci in the prostate. In addition, clinically irrelevant tumors can be differentiated from aggressive tumors, thus avoiding unnecessary surgery.
Multiparametric MRI of the prostate allows for an early stage detection of prostate cancer with a high degree of accuracy. At the same time prostate cancer can be ruled out with a high degree of probability if the images are normal.
Although mpMRI of the prostate is not a substitute for a biopsy, it significantly increases biopsy accuracy. MpMRI contributes to a reduced number of tissue results that indicate the abcense of cancer although cancer is actually present– so-called “false negative biopsies.”
MRI examinations may simplify prostate cancer detection. However, a residual risk of non-detection remains and there is a lack of information about the grade of aggressiveness of the tumor (Gleason score).
For this reason, we introduced perineal MRI-guided fusion biopsy (PFB) in 2012. In PFB, the available MRI images are mergedwith live transrectal ultrasound images using special software. This technique enables a targeted biopsy of suspicous tissue areas approached from the perineum (“perineal”). In contrast to sampling during MRI, a simultaneous systematic biopsy of the prostate during perineal MRI guided fusion biopsy is possible without any problems, further improving the carcinoma detection rate. Detailed information about the characteristics of the positive biopsies also enables optimal surgical planning.
This diagnostic procedure can be performed easily under short anesthesia. It takes approximately 25 minutes. The perineal technique minimizes the risk of prostate inflammation because there is no injury to the rectal wall, thus preventing the possible spread of bacteria from the intestine to the prostate. Image parameters of other imaging techniques (e.g., PSMA PET) can also be merged.
PSMA-PET/CT is currently the most accurate imaging technique for detecting or ruling out metastases in the diagnosis of prostate cancer. Detailed imaging using computed tomography (CT) is combined with positron emission tomography (PET), a technique that visualizes the metabolic activity of cells. The patient is injected with a weak radioactive labeled substance that is important for cell metabolism. Accumulation of the labeled substance in the prostate cancer cells allows for effective imaging (PSMA stands for prostate-specific membrane antigen). Our Clinic for Nuclear Medicine offers comprehensive PET-CT diagnostics using the latest generation of equipment.
Thanks to this precise detection method, both prostate cancer and metastases can be reliably identified. The results of a PSMA PET/CT examination thus enable optimal therapy planning. This modern, highly sensitive method is also applied for the detection of tumor recurrence after previous treatment and contributes to the decision making on future treatment options.
Learn more about the treatment options for prostate cancer here.
