In the context of the fight against prostate cancer, university doctors analyze the severity of the tumor. In some cases, immediate surgery can be avoided.
No type of cancer affects men like prostate cancer, with 60,000 new cases discovered in Germany each year. But there’s also encouraging news: In many cases, prostate cancer grows relatively slowly. “Meanwhile, five years after diagnosis, about 93 percent of those affected are still alive, and after ten years it’s still 90 percent,” says Prof. D. Christian Steve, MD, Chief of Urology at LMU Klinikum. More than 1,500 prostate patients are treated each year by his team of specialists in Munich-Groschadern. “About 70 percent of newly discovered prostate cancers must have surgery—primarily to prevent cancer cells from spreading to other organs and forming secondary tumors, so-called metastases,” says Steve.
Active surveillance rather than immediate surgery if the nature of the prostate cancer allows
However, there are also more and more cases in which radiotherapy, which was very technologically advanced at the same time, offers good treatment alternatives. It is not uncommon for doctors to do something initially to fight the tumor. This strategy is called “active surveillance” in English – in German: active surveillance. BACKGROUND: Doctors can now accurately analyze precancerous areas so that they can assess potential risks over the next few years. To put it simply: If a patient has a relatively less aggressive cancer (called a low-grade metastasis in technical terminology), they don’t necessarily have to have surgery initially.
Analysis of the tumor using a procedure called a fusion biopsy
The basis of this personalized or individualized treatment strategy is a professional diagnosis. Today, fusion biopsy is the key to tumor analysis. Explains Assistant Professor Dr. Maria Apfelbeck, who is in charge of this procedure at the University Urology Clinic in Großhadern.
Prostate cancer: Ultrasound and MRI are combined
During a biopsy, the doctor takes a sample of suspicious tissue from the prostate. To do this, she pricks the gland with a fine needle — always under anesthesia. For orientation, there was only an ultrasound image. But in a fusion biopsy, the live ultrasound image is combined with images from a magnetic resonance imaging (MRI) scan of the prostate. The reason: Altered tissue is easier to identify on MRI images. “This allows us to target suspicious tissue more precisely with the needle,” says Apfelbeck.
Professor Christian Steif: Prostate cancer prediction accuracy is relatively good
The prediction accuracy of this high-tech method is relatively good. Chief urologist Stief: “We can clarify three questions with 60 to 90 percent probability: First, whether we’re really dealing with cancer. Second, whether it’s an aggressive tumor. And third, whether the cancer is still confined to an organ or is it It has already spread.”
New England Journal of Medicine: Better detection of dangerous tumors
Scientific evaluations also prove how important this technical development is. A study published in the New England Journal of Medicine shows that dangerous tumors can be better detected with a fusion biopsy than with the traditional pure ultrasound method. At the same time, the MRI-assisted procedure reveals fewer — accidentally discovered — smaller tumors that don’t need to be treated at all.
This is how the prostate is examined
For the patient, the course of a fusion biopsy is hardly different from the ultrasound method, which has been used as a standard procedure for decades. The examiner inserts the ultrasound probe into the anus – however, he previously imported the MRI images he brought with him into the ultrasound machine’s computer. He can now see – shown in color – on the screen whether he is at the fine sampling point with his biopsy needle, orient himself as with some kind of navigation system.
PD Maria Apvelbeck: The result of the fusion biopsy is available after two to five days
“The scan only takes about a quarter of an hour, and the result is available after about two to five days,” explains Apfelbeck. The patient ultimately decides whether the biopsy needle is inserted through the rectum or perineum. The perineal type is somewhat more painful, so it is often performed under general anesthesia, depending on the patient’s desire. On the other hand, the risk of infection is slightly lower. Because if the rectum is punctured by the needle, there is a greater risk of bacteria entering the prostate. “However, this residual risk is very low,” says Appelbeck. With fusion biopsies, serious complications occur in less than one percent of cases. Aside from the fact that early diagnosis of cancer greatly improves the chance of recovery and can even be life-saving.
This article only contains general information on the relevant health topic and is therefore not intended for self-diagnosis, treatment or medication. It does not in any way replace a visit to the doctor. Unfortunately, our editorial team is not able to answer individual questions about clinical images.
