The most biopsies are redundant / Modern combination of imaging procedures gives more precise results / Big progress in the diagnosis of the prostate cancer in the Heidelberg Clinic for Prostate Therapy
(Heidelberg, 2018-01-22) Prostate biopsies are often needed but are always risky. Using a modern procedure of combination of magnetic resonance imaging (MRI) with ultrasound images, the number of extraction of samples (biopsies) can be minimized. The big advantage is: In case of a normal finding after the performance of the imaging procedure, a biopsy can completely be avoided.
The Heidelberg Clinic for Prostate Therapy has specialised in the non-invasive diagnosis and treatment of prostate diseases for almost twenty years. This includes both benign changes and cancer such as prostate carcinoma (PCa). A prostate carcinoma is certainly difficult to detect, as it is very small in the early stages and difficult to palpate in early cancer diagnosis. Even a blood test for the determination of the prostate-specific antigen (PSA value) provides no guarantee, but is at best an indication of cancer. Therefore, urologists often recommend the extraction of samples of the prostate (biopsy).
However, this standard form of tissue removal has a major disadvantage: in many cases it is performed by a random principle of sampling and some tumors remain undetected. “If a biopsy is really needed, it must be performed correctly and limited to as few samples as possible,” is the opinion of Dr. Thomas Dill who, together with Dr. Martin Loehr runs the Heidelberg Clinic for Prostate Therapy. The Heidelberg-based urologists have made the best experience with the combination of magnetic resonance imaging (MRI) with a specific ultrasound machines for more than 5 years. It allows localizing the tumors almost clearly and avoiding the redundant biopsies.
The Heidelberg-based specialists use a millimetre-accurate grid known as a template. This is fixed securely to the operating table and becomes the guide template for the biopsy needle. Suspect tissue can be accessed accurately and samples can be taken. And what is the advantage of the new diagnostic procedure? “For a start, you must understand how a biopsy is normally performed. Generally speaking, between ten and twelve randomly distributed tissue samples are extracted through the rectum from the prostate, by means of a blind procedure,” criticizes Dr. Martin Loehr. The accuracy rate for a prostate carcinoma is at most 30 percent, meaning that many patients subsequently require repeat biopsies before the tumor is detected.
The main advantage of the combination of imaging procedures is that the fusion of information from the magnetic resonance tomography and the ultrasound can target suspicious areas very precisely. Internal investigation in case of suspicion of cancer has shown a detection rate of around 90 percent. To put it in another way, the biopsies become unnecessary and if the biopsy will have to be performed, it gives information for the choice of the following treatments. It means, that due to the reliability of the biopsy results the urologist can choose a proper treatment with more certainty. If the tumor exists, it will be found.
Another advantage of the procedure: Extracting samples through the rectum involves an increased risk of transferring germs from the rectum into the prostate. The Heidelberg-based urologists also warn that blood poisoning, should it occur, can even result in loss of life. They do not perform biopsies through the rectum, but rather through an area of skin at the perineum, which can be disinfected properly prior to the biopsy.
Only if the results are positive, a treatment can be performed which involves at the Heidelberger Clinic for Prostate Therapy either a high intensity and focused ultrasound treatment based on the HIFU/Sonablate procedure or IRE. IRE stands for the irreversible electroporation, the procedure uses short electrical pulses to effectively destroy cancer cells. The Heidelberg urologists are using this treatment for the very first time in Germany as a standardized procedure for the treatment of prostate cancer.“Non-invasive treatment and precise, non-invasive diagnostics go hand in hand,” says Dr. Thomas Dill. Treatment can only be performed in those areas in which the presence of tumour cells has been confirmed. Tumour-free areas can be spared so that the functions of the prostate may be preserved.
Clinic contact data:
Klinik für Prostata-Therapie GmbH
Bergheimer Straße 56a
Telefon: +49 6221 / 65085-0
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