2024-01-15 12:45:04
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Urologist with passion: Professor Christian Stief is one of Germany’s most experienced prostate cancer specialists and is a member of the Leopoldina, the National Academy of Sciences. © ACHIM FRANK SCHMIDT
In the fight against prostate cancer, university doctors are analyzing how dangerous the tumor is. In some cases, immediate surgery can be avoided.
No other type of cancer affects as many men as prostate cancer; 60,000 new cases are discovered in Germany every year. But there is also encouraging news: In many cases, prostate cancer grows comparatively slowly. “Around 93 percent of those affected are still alive five years after diagnosis, and 90 percent after ten years,” says Professor Dr. Christian Stief, the head of urology at the LMU Clinic. His team of specialists in Munich-Großhadern treats well over 1,500 prostate patients every year. “Around 70 percent of newly discovered prostate cancers require surgery – primarily to prevent cancer cells from spreading to other organs and forming secondary tumors, so-called metastases,” says Stief.
Active surveillance instead of immediate surgery if the nature of the prostate cancer allows it
However, there are also more and more cases in which radiotherapy, which has now undergone massive technical upgrades, offers good treatment alternatives. It’s not uncommon for doctors to do nothing to combat the tumor. This strategy is called “Active Surveillance” in English – in German: Active monitoring. The background: Doctors can now analyze cancer sources so precisely that they can easily assess the risk potential in the next few years. To put it simply: If the patient has a comparatively less aggressive cancer (known in technical language as a low-malignant tumor), then he or she does not necessarily need to be operated on initially.
Tumor analysis using a procedure called fusion biopsy
Modern imaging makes it easier for doctors to analyze tumors, explains private lecturer Dr. Maria Apfelbeck. © Andreas Beez
The basis for such a personalized or individualized treatment strategy is professional diagnostics. Today, fusion biopsy serves as the key to tumor analysis. “It allows a relatively precise assessment of how aggressive the tumor is and whether it is still limited to the organ,” explains private lecturer Dr. Maria Apfelbeck, who leads this procedure at the Urological University Hospital in Großhadern.
Prostate cancer: Ultrasound and magnetic resonance imaging (MRI) are combined
During a biopsy, the doctor takes a sample of the suspicious tissue in the prostate. To do this, she sticks a thin needle into the gland – always under anesthesia. Previously there was only an ultrasound image for guidance. But with a fusion biopsy, the live ultrasound image is combined with 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 answer three questions with a probability of around 60 to 90 percent: Firstly, whether we are actually dealing with cancer. Secondly, whether it is an aggressive tumor. And thirdly, whether the cancer is still limited to the organ or has presumably already spread.”
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New England Journal of Medicine: Dangerous tumors are better recognized
Scientific evaluations also prove how valuable this technical development is. A study published in the New England Journal of Medicine showed that fusion biopsy can detect dangerous tumors better than the conventional ultrasound-only method. At the same time, the MRI-assisted procedure reveals fewer, accidentally discovered, smaller tumors that do not need to be treated at all.
This is how the prostate examination works
For the patient, the fusion biopsy process 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 – but first he has imported the MRI images into the ultrasound machine’s computer. He can now see exactly on the screen – shown in color – whether his biopsy needle is at the exact removal point; he can orientate himself like with a kind of navigation system.
PD Dr. Maria Apfelbeck: The results of the fusion biopsy are available after two to five days
“The examination only takes about a quarter of an hour and the results are available after about two to five days,” explains Apfelbeck. The patient ultimately decides whether the biopsy needle is inserted through the rectum or through the perineum. The perineal variant is a little more painful, which is why it is often done under general anesthesia, depending on the patient’s wishes. On the other hand, the risk of infection is somewhat lower. Because if the rectum is pierced by the needle, there is a greater risk of bacteria getting into the prostate. “However, this residual risk is very low,” says Apfelbeck. Serious complications only occur in less than one percent of cases with fusion biopsy. Apart from that, an early diagnosis of cancer can massively improve the chance of recovery and 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. It in no way replaces a visit to the doctor. Unfortunately, our editorial team cannot answer individual questions about medical conditions.
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