Previous prostate cancer screening
According to experts, conventional prostate cancer screening is useless or even dangerous.
“Palpation of the prostate, the digital rectal examination, or DRU for short, is useless,” says Patric Walsh, head of urology at Johns Hopkins University. In Germany it is still standard and the PSA test has been abolished as a screening test in many countries because an elevated PSA level often triggers an unnecessary biopsy, but a low PSA level does not rule out carcinoma.
So what should men do if they want to protect themselves against prostate cancer? The answer has been clear and scientifically proven for years: Magnetic resonance imaging (MRI) of the prostate can detect or rule out carcinomas with a high degree of certainty.
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Prostate-MRI
The new quality standard in prostate diagnostics.
The PROMIS multicenter study from England1 conducted in 2017 with 576 men was already able to show that MRI of the prostate has a detection sensitivity of 93% for clinically relevant prostate carcinomas, which is almost twice as high as prostate biopsy (TRUS biopsy), which only achieved a sensitivity of 48%.
These data were confirmed by the results of a large multicenter interdisciplinary study in the USA, which included a total of 1500 patients over several years2.
Clinically relevant carcinomas
MRI detects clinically relevant carcinomas with almost 100% certainty.
The researchers demonstrated that multiparametric MRI (mpMRI) of the prostate has a sensitivity for prostate cancer of 94-95%. Of note, MRI was able to exclude clinically relevant carcinomas (Gleason score ≥ 7) with a certainty of 93-97%. If the difficult to detect, almost benign Gleason 6 carcinomas were also taken into account, the negative predictive value was still 87% – much better than with the punch biopsy.
The size and extent of carcinomas in the prostate are also better detected by mpMRI than by punch biopsy, with a sensitivity of 84%. Infiltration of the seminal vesicles and tumor growth exceeding the prostate can be detected with a specificity of 97-98% (Gleason score ≥ 7).
MRT HELPS TO AVOID UNNECESSARY BIOPSIES
Modern examinations using MRI lead to reliable diagnoses.
That magnetic resonance imaging (MRI) can avoid unnecessary biopsies of the prostate has been suspected for years. In 2018, a study by the University of Mainz also provided scientific evidence of this in Germany3. They were able to show that among the 651 men in the study, nearly 40% of biopsies could have been avoided by MRI without missing relevant cancer foci.
In summary, it can be said today that the informative value of prostate MRI is so superior to other procedures that prostate MRI should be performed whenever prostate cancer is suspected.
- If a carcinoma requiring treatment (clinically relevant) is present, this is detected by prostate MRI with a detection sensitivity of 94 – 95%.
- If prostate MRI shows no suspicious findings, clinically relevant carcinoma can be excluded with 93-97% confidence.
- Prostate MRI detects the size and extent of carcinomas in the prostate with 84% accuracy, and capsule-spanning growth with 97-98% confidence.
- Prostate MRI can avoid unnecessary biopsies when PSA levels are elevated or increase the accuracy of biopsies when they are necessary.
Air in the rectum – prostate gone
The problem of susceptibility artifacts at 3 Tesla.
3 Tesla MRI scanners pose challenges to users that few experts have mastered. It requires a sound knowledge of physics, which most physicians do not have.
For example, most MRI scans of the prostate do not look to see if there is air in the rectum. This is because magnetic fields are sensitive to the different magnetic conductivity (susceptibility) of air and water-containing tissues – as occurs at the interface of the air-filled intestine and the prostate directly in front of it. These so-called susceptibility differences lead to a distortion of the magnetic field and thus to signal cancellations, which particularly affect the outer zone of the prostate near the rectum – where 70 to 80% of all carcinomas are located!
However, this problem can be solved by using 3T endorectal coils, simple gel, or a balloon filled with perfluorocarbon (without an antenna).
