Madrid, June 10, 2021 - The use of new technologies in the diagnosis of prostate cancer, like fusion biopsy, is a great advance in the early detection of this type of tumor, which affects 35,000 new people every year in Spain1, as was stated by Dr. Carlos Nuñez, Head of the Urological Surgery Service at MD Anderson Cancer Center Madrid, within the framework of World Prostate Cancer Day, which is this Friday, June 11.
The technique means the level of prostate cancer detection can be increased to 97% and that 30% more aggressive cancers can be diagnosed that would otherwise have gone unnoticed in a traditional biopsy. “Furthermore, it makes it unnecessary to have to do traditional biopsies at every check-up, making up to 40% avoidable. They are only needed for the initial diagnosis and, at subsequent follow-ups, only if there are alterations in the tests”, says the doctor.
Fusion biopsy, which is recommended when the prostate specific antigen (PSA) test is suspicious, is a minimally invasive procedure that offers a highly accurate anatomical map of the prostate showing the areas affected by the tumor, since it combines images of prostate obtained with MRI and ultrasound, creating detailed, three-dimensional images of the organ. This makes it easier to identify abnormal areas of tissue and to guide the biopsy needle to the areas affected.
Thanks to this test, targeted treatments, like focal therapy, can be applied, thus avoiding radical prostatectomy. Between 10% and 15% of prostate cancer cases are candidates for focal therapy and, of these, 9 out of 10 are usually treated, excluding those whose tumor is very close to the sphincter, in which case it is preferable to opt for surgery to avoid damaging the sphincter, states Dr. Nuñez. "Of those treated with focal therapy, the cure rate is above 70%-80% at five years, with 100% continence and 90% preservation of sexual function”.
PI-RADS system
Dr. Nuñez explains that to calculate the probability of a suspicious area really being cancer, in radiology the Prostate Imaging-Reporting and Data System (PI-RADS) is used, with scores ranging from 1 to 5. Between 1 and 2 are usually considered benign and above 3, a biopsy should be done to confirm whether or not it is cancer, of which between 40% and 50% are usually positive. If a PI-RADS 4 is obtained, the positive results increase to 70% -80%, and when the data reflect a PI-RADS score of 5, 90% of these cases are confirmed as cancerous tumors.
"It is true that there are between 30% and 40% of tumors in which the lesions are not identified in MRIs, but of these, the majority are not very aggressive tumors", states the urologist. And, in fact, there are still 5% of cases that are diagnosed only by digital rectal examination. "We must not underestimate any technique, they all help the diagnosis”.