the importance of a multiple diagnostic approach
By Dr. Carlo Bellorofonte – Medical Surgeon, Urology and Andrology specialist – Columbus Clinic Center
About Integrated Diagnosis
Integrated Diagnosis is based on the execution of multiple tests, using different methods, aimed at obtaining an accurate diagnosis of prostate cancer.
PSA – Prostate-specific Antigen
PSA is an enzyme produced by prostate cells (not by the neoplasm) which can release it into the blood. High PSA levels may indicate a prostate tumor. However, this marker may be altered even in case of infection (prostatitis) or Benign Prostatic Hypertrophy (BPH). Thus the need to associate PSA with other parameters, so as to obtain two different diagnostic indicators, that is, PSA VELOCITY and PSA DENSITY. The former is a measure of how fast the enzyme rises over a given period of time – studies have shown that this value increases rapidly in men with prostate cancer; PSA DENSITY, instead, is the PSA level in comparison to the size of the prostate gland.
Yet, the PSA is not enough to decide.
Electromagnetic diagnostics is a modern technique for the diagnosis of prostate tumors designed to avoid the inconvenience of invasive traditional investigations. Unlike the latter, in fact, the probe is applied externally and is able to examine the prostate gland through the emission of electromagnetic waves. Not only is this technology non-invasive and with short delivery timing (a few minutes), but it also enables accurate diagnosis of even the smallest lesions in the 90% of cases.
Rectal Examination (DRE)
Rectal Examination involves feeling the prostate by rectal palpation. This is one of the most invasive and bothersome diagnostic methods and, despite being useful to verify the presence of hard spots or other abnormalities, this test remains little accurate to this day, as it doesn’t even allow complete examination of the prostate gland.
This diagnostic test measures the flow of urine during urination. The test is performed using a flowmeter, which records information and generates a visual representation of urine flow. The quality of urinary flow is important in the therapeutic definition of this pathology.
Transrectal Ultrasound (TRUS)
Transrectal Prostate Ultrasound is another technique used to detect possible prostate carcinomas. The investigation requires insertion of an ultrasound probe into the rectum in order to create an image of the prostate area. The same equipment is used to perform prostate biopsy and to determine PSA DENSITY.
Multiparametric magnetic resonance imaging
Multiparametric magnetic resonance for prostate imaging (mpMRI) is useful in patients with high clinical suspicion of prostate cancer, especially if previous biopsy tests have already proved negative. The MRI technique is based on the use of magnetic fields and allows the generation of images of the prostate gland. Thanks to particular sequences used for the analysis of prostate tissue, it is possible to spot suspicious areas of neoplastic disease more accurately.
MRI-Transrectal ultrasound FUSION-guided prostate biopsy
This prostate biopsy procedure uses images obtained from a previously performed multi-parametric MRI which are fused to real-time transrectal ultrasound images.
The test involves collecting targeted samples of suspect areas; if necessary, random sampling of the rest of the prostate gland is also done. The biopsy takes about 20-30 minutes and is performed under sedation to avoid any disturbance to the patient.
It is carried out as the definitive test, only after integrated diagnostic techniques have shown that there is reasonable suspicion of prostate cancer disease.