Less biopsies thanks to new ultrasound procedure

Prostate cancer: New ultrasound procedure reduces biopsies

04/14/2014

Prostate cancer is the most common cancer in men in Germany. But in the precaution pinch many gentlemen, partly because of the fear of rectal palpation. A new ultrasound procedure should now at least significantly reduce the number of biopsies.

Prostate cancer is the most common cancer in German men
In men in Germany, prostate cancer is the most common cancer and the third most common cause of cancer death. According to the Robert Koch Institute (RKI), the number of new cases has risen steadily in recent years. From the age of 45, every man in Germany is entitled to a prostate cancer screening every year. Nevertheless, many men pinch in the early detection. But it is not only the fear of unpleasant examinations, but also the procedures are repeatedly discussed. For example, the tumor marker PSA causes some confusion, as it not only indicates dangerous developments, but also outet harmless tumors and thus can trigger unnecessary fears and treatments.

Experts discuss benefits of PSA testing
If a man decides after the palpation also for a PSA value determination and this inflammatory value is too high, then as a precaution tissue samples are taken from the prostate. Currently, these are about ten to twelve per check. Urologists repeatedly discuss the benefits of such PSA tests and some experts and organizations such as the German Society of Urology (DGU) even warn against using the blood test as mammography in breast cancer screening, because the study can save lives, but also on the one hand cause fatal false alarms. Currently, long-term studies are underway that allow a harm-benefit analysis of the PSA test.

Ultrasound procedure could significantly reduce number of biopsies
Now the Flensburg urologist Tillmann Loch advertises an ultrasound procedure that could significantly reduce the number of such biopsies. However, the Urologists Association does not participate, because larger studies on computer- and database-supported ultrasound analysis are missing. From Lochs point of view it looks so easy: „It is about narrowing suspicious areas and taking tissue samples much more targeted than before.“ The urologist uses his colleagues to compare the ultrasound recordings with a large database of prostate cancer cases and mark those areas in front of the mask that could harbor dangers. Loch explained that only six instead of one to twelve biopsy punctures were needed. This will also save money.

Several therapy methods are possible
In Germany, more than a hundred practices already work with the C-Trus / Anna procedure. Although Loch's team has already examined thousands of ultrasound images, only those of 60 patients were evaluated in one study. The board of the foundation Men's Health and former president of the German Cancer Society, Lothar Weißbach, finds that this number is too small. „Prostate cancer is a ubiquitous cancer - it occurs everywhere in the prostate“, so Weissbach. He therefore considers it necessary to continue doing 12 biopsies per check in the current data. When the urologists find what they are looking for, the next question is how the treatment will continue, as the extremely slow-growing tumors are usually detected at an early, localized stage, and several therapeutic modalities are possible. The spectrum ranges from close observation to hormone administration, radiation and surgical removal of the prostate.

Funding from Gazprom calls critics on the scene
In mid-April, Lothar Weißbach intends to present the results of a first large, five-year study with 3,300 participants from Germany, which should underline the effectiveness of so-called active surveillance. The PSA value with a palpation finding and possibly biopsies every three years is used successfully. „At present, surgery is overwhelming as a method of choice, but that will change“, says Weissbach. However, the non-randomized study was funded by Gazprom and called critics on the scene for that reason alone.

Large study should allow evaluation of different treatment approaches
The German Urology Society (DGU) is now also working to evaluate the long-term treatment approaches of low-risk carcinoma. In January 2013, they launched the largest ever study on prostate cancer, which will involve more than 7,000 men and should continue with aftercare until 2030. Although so far only 80 patients have been recruited, study director Michael Stöckle recently said that they were satisfied with the start. „Now in the second year, however, the numbers must increase significantly“, so the doctor. The German Cancer Aid and the statutory and private health insurance companies will provide around 25 million euros by 2030 in order to enable an objective assessment of the different treatment options in this large-scale study. (Sb)