Prostate cancer diagnosis with ultrasound

Ultrasound could significantly improve the prostate cancer diagnosis

10/20/2011

Prostate carcinomas are the most common cancer in men in Germany. But unlike women and their participation in breast cancer screening, only a few men can be examined early. Although every man in this country from the age of 45 years annually entitled to a prostate cancer screening, the costs of which take over the health insurance.

But it is not only the relatively low participation of men in cancer detection that is responsible for the fact that only a fraction of prostate carcinomas is detected early. Even the relatively inaccurate diagnostic procedures lead to the fact that many prostate cancers are not recognized, report experts such as the urologist Hans Heynemann from the University Hospital Halle and Georg Salomon of the Martini-Klinik at the University Hospital Hamburg-Eppendorf opposite the „Tagesspiegel“. Ultrasound examination may be able to remedy this situation in the future and significantly improve the early detection of prostate carcinomas, the doctors hope.

Nearly 60,000 prostate cancers a year
Prostate cancer refers to a malignant tumor disease that originates from the glandular tissue of the prostate gland. Every year over 11,000 men in this country die of cancer of the 20 to a maximum of 40 grams, located below the urethra organ and 58,000 new prostate cancer cases are recorded annually, the experts report. This causes about ten percent of all cancer deaths in men due to carcinoma of the prostate and prostate cancer is the third leading cause of death among men after cancer of the bowels and lungs. In terms of new cases, prostate cancer is even the most common cancer in men. Since the disease is usually without conspicuous symptoms in the initial stage, most prostate carcinomas are only discovered at a significantly advanced stage of the disease. All the more important are appropriate preventive examinations, because with early detection of prostate cancer, the chances of successful treatment are significantly higher, the experts explained.

Right to prostate cancer screening
Every man in Germany is generally entitled to a prostate check-up after the age of 45 years. As a rule, changes in the prostate are palpated from the rectum. Participation in the check-ups, however, is relatively modest and the tactile method, according to the experts also has its limits. For example, it is possible to detect larger tumors on the prostate surface by touching them, other forms of prostate carcinoma can only rarely be determined in this way, explained urologist Hans Heynemann. According to the experts, enough „a single palpation without determining the PSA value is not enough.“ The PSA value stands for prostate-specific antigens (PSA), which can be detected in the blood of those affected. According to Heynemann, proteins that are produced by the cells of the prostate gland also enter the bloodstream in small quantities. This is the benefit of the PSA test.

However, the interpretation of elevated PSA levels is extremely complicated and sometimes these are not very meaningful, the experts complained. In addition, there are no studies to date that clearly show that a men's PSA screening - comparable to breast cancer screening in women - can statistically prolong men's lives. Thus, the guideline of the German Society of Urology explains that it has not yet been clarified whether PSA-based early diagnosis and the associated diagnostic and therapeutic risks can be outweighed by extending the life span of men. Therefore, until now, only men who explicitly insist on a PSA test in the context of early detection of cancer are being investigated. However, the costs are usually not covered by the health insurance companies. According to the experts, due to the uncertainties in the diagnosis prior to any prostate cancer screening, there should be an in-depth discussion between the patient and the doctor, which also addresses the difficult interpretation of the test results. In addition, men must be aware that if prostate cancer is suspected, there is no shortcut to taking ten to twelve small tissue samples for a clear diagnosis. Because only the examination of the tissue samples in the laboratory can guarantee a clear determination of the malignant cells.

Also, physicians and sufferers should always remember that not all tumors of the prostate gland require surgery, radiation or chemotherapy, stressed the experts. In addition, many middle-aged men have a benign enlargement of the prostate, which also requires no appropriate action. In part, waiting and observing could prove to be a wiser strategy, explained the doctors. Should the need for surgical or therapeutic intervention become apparent, however, its chances of success are greatest as long as prostate cancer has not yet started to spread and form metastases. Thus, a clear early detection of special significance, said Georg Salomon and Hans Heynemann compared to the „Tagesspiegel“.

Ultrasound for prostate cancer diagnosis
The experts described the use of ultrasound as a promising new method for prostate cancer screening. Even today, ultrasonography helps pinpointing the needles, and in the future ultrasound may even make it unnecessary to take tissue samples, according to the physicians. According to Georg Salomon of the Martini-Klinik at the University Hospital Hamburg-Eppendorf, doctors use the so-called „Elastography the fact that cancerous tissue is usually harder than normal tissue“ and so with ultrasound differences are noted. With the help of imaging techniques, the differences can also be displayed on the monitor of the doctors, which is currently being tested in the world's largest study of more than 1,000 patients at the University of Hamburg-Eppendorf.

Early detection in the future without tissue removal?
As Georg Salomon explained, targeted tissue samples can be taken on the basis of ultrasound elastography, resulting in 20 percent more tumor patients being identified. The first results of the current study were presented by Salomon at a conference of the German Society for Ultrasound in Medicine in Berlin. One skilled in the art has high hopes for the ultrasound technique, emphasizing that sonography may in the future potentially make tissue sampling unnecessary for prostate cancer diagnosis. Because the doctors should „There's nothing hard about elastography“, could a tissue sample unnecessary. So far, however, the evidence is not sufficient to dispense with a tissue sampling, the expert continued.

In addition to the ultrasound examination of the rectum, the researchers also rely on contrast-enhanced sonography for prostate cancer screening. In the run-up to the examination, a special contrast agent is injected into the vein to make the blood flow in the prostate visible. Tumor tissue forms new blood vessels „in a chaotic way“, The urologist of the Munich University Hospital, Michael Seitz, emphasized that the blood circulation is also evident. However, the route to the screening would also be extremely far in this process, since the acquisition of appropriate equipment and the contrast agent are associated with significant costs and so far only a small circle of experts could interpret the results of the investigation, stressed the Munich urologist. (Fp)

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Image: Dieter Schütz