2023-04-21 17:00:00
In the fight against prostate cancer, university doctors analyze how dangerous the tumor is. In some cases, immediate surgery can be avoided.
No type of cancer affects as many men as prostate carcinoma, with 60,000 new cases being discovered in Germany every year. But there is also encouraging news: in many cases, prostate cancer grows comparatively slowly. “Meanwhile, five years after the diagnosis, around 93 percent of those affected are still alive, and after ten years it’s still 90 percent,” says Professor Dr. Christian Stief, the head of urology at the LMU Klinikum. Well over 1,500 prostate patients are treated every year by his team of specialists in Munich-Großhadern. “About 70 percent of the newly discovered prostate carcinomas have to be operated on – mainly to prevent cancer cells from spreading to other organs and forming secondary tumors, so-called metastases,” says Stief.
Active monitoring instead of immediate surgery if the nature of the prostate cancer allows it
However, there are also more and more cases in which radiation therapy, which has meanwhile been massively upgraded technically, offers good treatment alternatives. It is not uncommon for doctors to do nothing at first to fight the tumor. This strategy is called “active surveillance” in English – in German: active monitoring. The background: Doctors can now analyze cancerous areas so precisely that they can assess the risk potential over the next few years. To put it simply: If the patient has comparatively less aggressive cancer (called a low-grade malignant tumor in technical jargon), then it does not necessarily have to be operated on at first.
Tumor analysis using a procedure called fusion biopsy
The basis for such a personalized or individualized treatment strategy is professional diagnostics. Today, fusion biopsy is the key to tumor analysis. “It allows a relatively accurate assessment of how aggressive the tumor is and whether it is still limited to the organ,” explains associate professor Dr. Maria Apfelbeck, who is in charge of this procedure at the Urological University Clinic in Großhadern.
Prostate cancer: Ultrasound and magnetic resonance imaging (MRI) are combined
During a biopsy, the doctor takes a sample from the suspicious tissue in the prostate. To do this, she pricks the gland with a thin needle – always under anesthesia. For orientation, there used to be only an ultrasound image. But in a fusion biopsy, the live ultrasound image is combined with the images from a previously performed magnetic resonance imaging (MRI) of the prostate. The reason: changed tissue is easier to recognize on MRI images. “This allows us to target the suspicious tissue much more precisely with the needle,” reports Apfelbeck.
Professor Christian Stief: Prediction accuracy for prostate cancer is relatively good
The prediction accuracy of this high-tech method is relatively good. Chief urologist Stief: “We can clarify three questions with a probability of around 60 to 90 percent: First, whether we are actually dealing with cancer. Second, whether it is an aggressive tumor. And thirdly, whether the cancer is still limited to the organ or has presumably already spread.”
New England Journal of Medicine: Better detection of dangerous tumors
Scientific evaluations also prove how valuable this technical development is. A study published in the New England Journal of Medicine showed that dangerous tumors can be detected better with fusion biopsy than with the conventional pure ultrasound method. At the same time, the MRI-supported procedure reveals fewer – accidentally discovered – smaller tumors that do not have to be treated at all.
This is how the examination of the prostate works
For the patient, the course of the fusion biopsy hardly differs from the ultrasound method, which has been used as the standard procedure for decades. The examiner basically inserts an ultrasound probe into the anus – however, beforehand he has imported the MRI images he has brought with him into the computer of the ultrasound device. He can now see – shown in color – on the screen whether he is at the exact sampling point with his biopsy needle, he can orientate himself like with a kind of navigation device.
PD dr Maria Apfelbeck: The result of the fusion biopsy is available after two to five days
“The examination 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 the perineum. The perineum variant is somewhat more painful, so it is often performed under general anesthesia, depending on the patient’s wishes. 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 getting into the prostate. “However, this residual risk is very low,” says Apfelbeck. With fusion biopsies, serious complications occur in less than one percent of cases. Apart from the fact that an early diagnosis of cancer greatly improves the chance of recovery and can even be life-saving.
This article only contains general information on the respective health topic and is therefore not intended for self-diagnosis, treatment or medication. In no way does it replace a visit to the doctor. Unfortunately, our editorial team cannot answer individual questions about clinical pictures.
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