When I should make a screening?
Prostate cancer occurs with increasing frequency, even in younger men. Contrary to benign prostatic hypertrophy (BPH) or prostatitis most prostate cancers do not cause any symptoms and are visible when it is too late.
Therefore, annual prostate cancer screening is recommended for men aged 50 or above. For patients who have first degree relatives with prostate cancer, screening should commence at the age of 40.
Routine screening is not accurate enough
Screening for prostate cancer usually comprises blood testing for PSA (prostate-specific antigen) and a digital rectal exam of the prostate gland. Whilst easy to perform and cheap, prostate cancer can be missed by these tests. On the other hand “false positive” findings can mimic cancer, albeit being benign changes of no importance.
Percentage of men harboring a prostate cancer (PC) as a function of the PSA-level. Whilst in Germany a biopsy is recommended with PSA > 4 ng/ml, in the US the threshold for biopsy is 2.5 ng/ml.
Ordinary biopsy defines the diagnosis only in up to 35% of cases
For further evaluation a transrectal biopsy (tissue sample through the rectum) is carried out in many cases. This test, however, yields a definitive diagnosis in only 30 to 35 % on average.
|Biopsy Technique||Number of Biopsies||Detection Rate|
|Sextant||6||20 to 30 %|
|Sextant + transitional Zone||8||+ 10 to 15 % (TZ)|
|Extended Sextant Biopsy||10||35 %|
|5-Region Biopsy||11||35 %|
|Extended Biopsy||12 – 14||30 to 40 %|
|Maximal(Saturation)-Biopsy||> 14 to 25||34 %|
Typically between 6 and 12 tissue samples are taken from the prostate. Although broadly established, the method is fraught with disadvantages:
- It is perceived as painful and does not allow a precise tumor localisation.
- Further, because the biopsy is carried out through the rectum, which is not sterile, bacteria are inevitably spread into the prostate, which can result in infections of the prostate (prostatitis).
“Biopsy-Free” Diagnostic of the Prostate is more accurate and safe
As an alternative to a biopsy a non-invasive (“biopsy-free”) diagnostic work-up can be chosen initially, employing endorectal magnetic resonance imaging (MRI) and spectroscopy (MSR).
Advantages of the “Biopsy-Free”-Diagnostic:
- These methods afford accuracy for the detection of prostate cancer of 80 % and above.
- Further, they provide information about the location of a potential carcinoma in the prostate, such that a subsequent biopsy can be carried out more accurately.
Endorectal-MRI of a carcinoma of the right lobe of the prostate spreading beyond the prostatic capsule with beginning infiltration of the rectum (yellow arrows) and the seminal vesicles (red arrow). Lymph node metastases (green arrows).
Multi-modal MR-Diagnostic Imaging: Most Accurate Imaging Technique for Prostate Cancer Detection
Contrary to other imaging techniques (Computed tomography, ultrasound imaging, szintigraphy, positron emission tomography) MRI provides multiple mutually independent parameters for the assessment of the prostate: T1- und T2-relaxation time, tissue susceptibility, water diffusion, tissue perfusion and spectroscopic information about metabolism.
Due to this, MRI is superior to other imaging techniques such as ultrasound and also when compared to elastography.
The four pillars of multi-modal MRI diagnostics of prostate cancer: Imaging, diffusion, perfusion and spectroscopy.
Also the analysis of the chemical composition of prostatic tissue makes the diagnostic with MSR (MR-Spectroscopy) so precise and valuable.
Prostate spectroscopy depicts the chemical make-up of prostatic cells. Healthy cells contain large amounts of citrate and little cholin. Cancer cells contain less citrate, which is metabolised for the generation of energy, and more cholin, which is needed for the assembly of the cell membranes in the tumour cells (note the different scaling of the y-axes –red circles)
Costs for the “Biopsy-Free”-Diagnostic
The costs for “Biopsy-Free”-Diagnostic are 2875 euro.
Duration of the diagnostic including consultation, preparation and evaluation of results is approximately 3 hours.
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After the “Biopsy-Free”-Diagnostic, if the prostate cancer was identified, the 3D-Biopsy could be done in order to specify the target (cancer cells) for the treatment.