- The standard practice for diagnosing prostate cancer includes an MRI test and, if necessary, a biopsy.
- Researchers say that an advanced imaging technique could help doctors better diagnose and treat prostate cancer.
- Experts say current testing methods are sufficient, but there are certain instances where advanced imaging could be useful.
An advanced imaging method could help medical professionals diagnose and treat prostate cancer by providing a clearer picture of tumors.
That’s according to a study completed at the University Hospital in Bonn, Germany, and presented at the European Association of Urology Annual Congress in Milan, Italy.
In their study, which hasn’t been published yet in a peer review journal, researchers analyzed PSMA-PET/CT scans. These look for prostate-specific membrane antigens (PMSA) found on the surface of prostate cancer cells.
Locating PMSA allows medical professionals to determine if the cancer has spread and, if so, to what other parts of the body.
The scientists also hoped the imaging could provide additional information for creating treatment plans.
Advanced imaging also helps doctors decide where they should take samples for biopsies.
Details on the prostate cancer imaging study
Since 2021, around 200 men have participated in the ongoing trial. Researchers hope to enroll 230 by the end of the study.
Thus far, they have examined data from 219 men who underwent MRI tests, PSMA-PET/CT exams, and a biopsy.
Two separate teams of urologists randomly looked at the scans.
One team was given the results from MRI, PSMA-PET/CT, and biopsy. The other team received results from the MRI and biopsy.
After reviewing the results, the researchers asked how the medical professionals would proceed with care.
After receiving the PSMA-PET/CT results, clinicians changed how they might treat patients with clinically significant prostate cancer in 19% of cases. The technique also helped detect more clinically significant prostate cancers. However, 6% of participants received a false positive.
The researchers note that because prostate cancer is sometimes slow-growing and can take years to return when adequately treated, they can’t clearly state how treatment decisions could affect patient outcomes.
Diagnosing prostate cancer
Currently, the standard practice is to use an MRI and biopsy to detect prostate cancer.
“Typically, blood tests that show elevated prostate-specific antigen (PSA) levels lead to an MRI. If this warrants it, we will do a biopsy. This process typically identifies around 90 percent of cancers,” said Dr. Shawn Dason, a urologic oncologist specializing in prostate surgery at The Ohio State University Comprehensive Cancer Center – Arthur G James Cancer Hospital and Richard J Solove Research Institute.
The cost of advanced imaging prevents it from being widely adopted. Healthcare systems may wait until they better understand how to use it effectively. In the meantime, the researchers suggest it might help with challenging diagnostic cases.
“It might be hard to improve on the current process,” Dason told Healthline. “But there are a few situations where I think it could help. The first is if PSA levels continue to rise, but we can’t find where the cancer is. The second is if we want to treat a portion of the gland rather than the whole gland, the additional imaging could help us be more precise.”
“However, this report only provides us with an outline of how they plan to conduct the trial,” Dason said. “We must wait for the final results, which could take years.”
Where advanced imaging might help
According to Dr, Rohan Garje, the chief of genitourinary medical oncology at the Miami Cancer Institute, part of Baptist Health in South Florida, other situations where advanced imaging could be helpful are:
- Patients with high-risk prostate cancer
- Recurrent prostate cancer with a PSA between 0.5 and 2.0
There are some ways treatment recommendations could change based on this imaging, Garje told Healthline.
- If metastatic disease is not detected using conventional imaging but is with advanced imaging, the treatment would change, and systemic therapy could be utilized.
- Treatment methods can be intensified or de-intensified based on the scan results.
- As the researchers pointed out, there is a potential to improve diagnostic accuracy by selecting biopsy sites based on imaging.
One of the downsides of using advanced imaging includes a risk of misdiagnosis.
“The radiotracers can bind to other types of cancers as well as benign lesions, which can cause errors interpreting the images,” Garje said. “Clinical judgment and experience with interpretation of these images is needed.”
Some doctors already use PSMA scans and find them helpful for diagnosis and to guide their treatment.
“I have used the PSMA scan to evaluate bone lesions in patients with suspected prostate cancer,” said Dr. Brian Norouzi, a urologist with Providence St. Joseph Hospital in California. “If those bone lesions are targeted explicitly by the PSMA scan, then the patient almost certainly has prostate cancer and potentially could be placed on treatment before the biopsy.”
“I have also used the scan to determine if a patient who has prostate cancer and enlarged lymph nodes from lymphoma has any harboring prostate cancer inside of those nodes.” Norouzi told Healthline. “I’ve used it to differentiate in large lymph nodes from lymphoma versus prostate cancer. As the study also suggested, I do look at those scans before removing the prostate for cancer to get an idea for the potential bulkiness of the cancer contained within the prostate.”
What to know about prostate cancer
Prostate cancer is common in men in the United States, second only to skin cancer, according to the American Cancer Society.
Around 288,300 men will be diagnosed with the disease in 2023 and approximately 34,700 of them will likely die.
According to the Centers for Disease Control and Prevention (CDC), some of the symptoms of prostate cancer include:
- Difficulty starting urination
- Weak or interrupted flow of urine
- Urinating often, especially at night
- Trouble emptying the bladder completely
- Blood in urine or semen
- Pain in the back, hips, or pelvis that doesn’t go away
- Painful ejaculation
Men can experience all, some, or none of these symptoms. Some men can have prostate cancer for years without knowing.
There are several different types of treatment for prostate cancer, according to the CDC:
- Watchful waiting means treatment isn’t necessary, but the patient should receive regular screening and symptoms treated as they appear.
- A prostatectomy is a surgery to remove the prostate. A radical prostatectomy removes the prostate and surrounding tissue.
- Radiation therapy can be internal or external. For internal, radioactive seeds or pellets are surgically placed near the cancer. External radiation uses a machine outside the body and directs a beam at the tumor’s area.
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