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Prostate cancer

Creating a world without fear of cancer 

Prostate cancer

Prostate cancer is cancer that occurs in the prostate. The prostate is a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

Cancer types men Belgium

With 71,647 cases in 2020 in Belgium, Prostate cancer was the most prevalent cancer type among men.

Incidence of prostate cancer

1 in 8 men will be diagnosed with prostate cancer in his lifetime.

Prostate cancer facts

32.3% five-year relative survival rate for patients with distant metastasis

Early detection of prostate cancer is of paramount importance for several compelling reasons:

  • Improved Survival Rates: When prostate cancer is diagnosed in its early stages, the chances of successful treatment and long-term survival significantly increase. Many cases can be effectively managed or even cured if detected before the cancer spreads beyond the prostate.  The relative 5-year survival rate for prostate cancer diagnosed in its earliest stages is nearly 100%. The survival rate for advanced disease drops to 32%.
  • Minimized Health Impact: Early detection allows for less invasive treatment options, reducing the potential side effects and complications associated with more advanced disease. This results in a higher quality of life for patients.
  • Individualized Treatment: Identifying prostate cancer early enables healthcare professionals to tailor treatment plans to each patient's specific needs, ensuring the most appropriate and effective interventions.
  • Reduced Anxiety: For individuals, knowing their cancer status early can alleviate the anxiety and uncertainty that often accompany the prospect of cancer. This can have a positive impact on mental and emotional well-being.
  • Less Aggressive Treatment: Advanced-stage prostate cancer may require more aggressive treatments, such as extensive surgery or radiation therapy, which can be physically and emotionally challenging. Early detection may lead to less aggressive treatment options, minimizing the burden on the patient.

Screening

A Comprehensive Portfolio of PSA Assays for Screening & Monitoring

Prostate-specific antigen (PSA) tests are utilized by a wide variety of healthcare professionals—including family physicians, urologists, and oncologists—to aid in the detection, monitoring, and management of prostate cancer. Different types of PSA tests can be used to guide decision making at different stages of the disease. They are clinically accepted by the NACB and EGTM for both detection and monitoring.1

Physicians will often employ a test that measures total serum PSA for frontline risk assessment. A free PSA (fPSA) test may be ordered when a patient exhibits a moderately elevated total PSA, and digital rectal exam (DRE) findings are not indicative of cancer.

Our PSA Assays have following benefits

  • Reduce unnecessary biopsies by using an assay that helps to discriminate between prostate cancer and benign prostatic diseases.4-6
  • Achieve accurate results with improved specificity in the detection of prostate cancer.3,4,6
  • Improve patient management with information on possible disease relapse.

The Siemens portfolio of PSA assays overview:

  • Atellica® IM PSA Assay: Intended for the measurement of serum PSA, in conjunction with a digital rectal exam (DRE), as an aid in the detection of prostate cancer in men aged 50 years and older. This assay is further indicated as an aid in the management (monitoring) of patients with prostate cancer.
  • Atellica® IM Free PSA (fPSA) Assay: Intended to be used in conjunction with the Atellica® IM PSA Assay in men aged 50 years or older with total PSA values between 4 and 10 ng/mL and a digital rectal exam (DRE) non‑suspicious for cancer to determine the percent free PSA value. The percent free PSA value can be used as an aid in discriminating between prostate cancer and benign prostatic disease.
  • Atellica® IM Complexed PSA (cPSA) Assay: Intended for the measurement of serum‑complexed PSA in conjunction with digital rectal exam (DRE) as an aid in the detection of prostate cancer in men aged 50 years or older. PSA complexed with alpha-1-antichymotrypsin (ACT) comprises a higher proportion of PSA in men with prostate cancer.2-4 This assay is further indicated as an aid in the management (monitoring) of prostate cancer patients.

Diagnosis 

Prostate MR

  • Our Prostate MRI technology allows for precise and non-invasive diagnosis, reducing the need for unnecessary biopsies.
  • Siemens Healthineers' AI-driven diagnostic tools help healthcare professionals interpret MRI images more efficiently and accurately.

Prostate MRI​​​​

Today, MRI is reaching maturity in its ability to manage prostatic disease. As well as helping to detect prostate cancer earlier and deliver more precise diagnoses, MR imaging can reduce harm to patients by allowing men with negative MRI findings to avoid unnecessary biopsies. Beyond detection and diagnosis, precision imaging also has a significant role to play in managing patients with diagnosed cancer. This can include smart and targeted imaging-guided treatments, efficient follow-ups, and effective monitoring of therapy results in patients with advanced prostate cancer.

Improve lesion conspicuity in DWI with ZOOMitPRO and RESOLVE

High-quality diffusion-weighted imaging is of utmost importance in multiparametric MRI of the prostate. With ZOOMitPRO and RESOLVE we provide two independent techniques to tailor the exam to every patient's needs:

RESOLVE reduces blurring and susceptibility to artifacts, i.e. in patients with gas in the rectum or artificial implants. The resulting images are largely free of distortions and provide high spatial resolution. With RESOLVE you are able to improve your clinical capabilities by using a technique that achieves diagnostic images even in patients with metal implants.2

ZOOMitPRO is a method for high-resolution, zoomed FOV imaging, allowing diffusion-weighted images with high contrast and resolution in short acquisition times.

AI-driven diagnostic tools

Our AI-Rad Companion Prostate MR is an AI-powered, augmented workflow solution for prostate imaging support. It assists radiologists in interpreting multiparametric MR DICOM images of the prostate and provides annotated images for targeted MR/US-fusion biopsies as well as a seamless information transfer to the urologist.

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AI-Rad Companion Prostate MR Vida Segmentation

The software automatically segments the prostate gland and marks the organ’s outer contour in a few seconds as opposed to the several minutes it takes to do so manually. It also calculates the volume of the gland.

The algorithm automatically detects, segments, quantifies, and classifies suspicious prostate lesions and provides this information along with a lesion score and a visualization of their localization on a pictogram.

The software then allows the radiologist to manually adjust the automatic segmentations, delete lesions, and edit the lesion score as well as the diameter and localization of the lesion.

The radiologist can also mark other potential targets for biopsy and add comments to ensure that no information is lost.

When the patient’s PSA (prostate-specific antigen) value is known, the software calculates the PSA density.

AI-Rad Companion Prostate MR Vida Segmentation
AI-Rad Companion Prostate MR Vida Segmentation Lesion
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AI-Rad Companion Prostate MR can improve mean detection performance, while reducing inter-reader variability and reading time. Scientific evidence shows that the average reading accuracy of experienced radiologists in detecting clinically significant cases (PI-RADS =4) increased by 4.4% from 0.84 to 0.88 in terms of area under the curve. Inter-reader concordance increased by 63% and the median reading time decreased by 21% from 103 to 81 seconds.9

Additional scientific evidence shows that less experienced readers profit most from using AI-Rad Companion Prostate MR. In terms of area under the curve, they reached performances comparable to those of experienced radiologists.10

Treatment Planning

Synthetic CT

While MR provides excellent soft-tissue contrast and functional information, CT is still required for electron density information for accurate dose calculation. As a result, many institutions have to adapt their RT treatment planning workflow, in which patients are normally scanned on both imaging modalities. Fusing CT and MRI modalities makes the workflow more complicated and adds uncertainties in the planning process.1, 2

MR-based Synthetic CT offers the possibility of combining the superior soft-tissue contrast of MRI for organs-at-risk and target delineation with dosimetric planning. An MR-only workflow eliminates the need for CT to MRI registration, reducing systematic registration errors and unnecessary ionizing radiation from CT scans.

MR-based Synthetic CT reimagined

An AI-based algorithm for continuous Hounsfield units in the pelvis and brain – with syngo.via RT Image Suite.

MR-based Synthetic CT offers the possibility of combining the superior soft-tissue contrast of MRI for organ at risk and target delineation with dosimetric planning. An MR-only workflow eliminates the need for CT to MRI registration, reducing systematic registration errors and unnecessary ionizing radiation from CT scans. Our latest solution for MR-only workflows includes an AI-based algorithm for generating Synthetic CT images from MRI for pelvis and brain.

Key features:

  • Geometric fidelity
  • Continuous Hounsfield units
  • Three different outputs are available: 120 kV equivalent, electron density, and mass density images
  • DICOM format
  • For brain and male/female pelvis
  • In-plane resolution of 1 mm x 1 mm (brain), 2 mm x 2 mm (pelvis)

Follow-up

PSMA-tracers for nuclear medicine

Prostate-specific membrane antigen (PSMA) is of benefit to medicine as it is a highly specific protein found on prostate cancer cells that can bind to small-molecule ligands. Coupled with a low- or high-dose radionuclide, a PSMA ligand is a tracer used in diagnostic PET/CT and endoradiotherapy.

The utilization of PSMA PET/CT in staging and restaging prostate cancer is increasingly recognized. Data show that PSMA PET/CT leads to a change in therapeutic management in about half of all patients with a biochemical recurrence of prostate cancer. Patients who have a PSMA PET/CT are less likely to receive systemic treatment, and radiotherapy can be more personalized.

Diagnosis and Staging: PETCT-scan with F18-PSMA

Biograph Vision’s fast 214-ps TOF, combined with 3.2-mm crystal elements that deliver a 440 x 440 acquisition matrix, makes it easier to see small lesions that can significantly improve lesion-detection performance for oncologic PET/CT imaging. Biograph Vision’s superb image quality provides exceptional results for a wide range of radiopharmaceuticals and imaging needs, including whole-body dynamic imaging, RT planning, and much more.

Treatment: Theranostics Ga-PSMA and Lu-PSMA

Theranostics is an innovative concept of personalized therapy that focuses on both the accurate selection of patients and providing them with targeted radioligand therapy to improve their prognosis. It refers to structurally similar diagnostic and therapeutic agents that share a molecular-specific target that involves the use of molecular imaging techniques to identify, personalize, and monitor therapy response. It makes use of pharmaceuticals, such as radioligands, to target and treat specific areas.

By imaging with targeted radioligands (eg, 68Ga-PSMA PET), you can plan radionuclide therapies using a similar. targeted ligand labeled with a therapeutic tracer (eg, 177Lu-PSMA).

1 NACB Laboratory Medicine Practice Guidelines. Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast and Ovarian Cancers. 2009. 
2 Brawer MK, Cheli CD, Neaman IE, Goldblatt J, Smith C, Schwartz MK, Bruzek D J,Morris DL, Sokoll LJ, Chan DW, Yeung KK, Partin AW, Allard WJ. Complexed prostate specific antigen provides significant enhancement of specificity compared with total prostate specific antigen for detecting prostate cancer. J Urol. 2000 Nov;164(5):1671-2. 
3 Lilja H, Christensson A, Dahlen U, et al. Prostate-specific antigen in human serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem. 1991;37(9):1618–1625. 
4 Stenman UH, Leinonen J, Alfthan H, et al. A complex between prostate-specific antigen and alpha-1-antichymotrypsin is the major form of prostate-specific antigen in serum of patients with prostatic cancer: Assay of the complex improves clinical sensitivity for cancer. Cancer Res 1991; 51: 222-6. 
5 Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, Richie JP, deKernion JB, Walsh PC, Scardino PT, Lange PH, Subong EN, Parson RE, Gasior GH, Loveland KG, Southwick PC. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998 May 20;279(19):1542-7. 
8 Lilja H. Significance of different molecular forms of serum PSA. Urol Clin North Am.1993;20(4):681–686.
9 Winkel. D.J. A Novel Deep Learning Based Computer-Aided Diagnosis System Improves the Accuracy and Efficiency of Radiologists in Reading Biparametric Magnetic Resonance Images of the Prostate: Results of a Multireader, Multicase Study. 2021. DOI: 10.1097/RLI.0000000000000780
10 Labus S. A concurrent, deep learning-based computer-aided detection system for prostate multiparametric MRI: a performance study involving experienced and less-experienced radiologists. 2022. DOI: 10.1007/s00330-022-08978-y