PSA is an enzyme that is produced by the glandular epithelium of the prostate and is added to the ejaculate. As a result, the ejaculate is liquefied in the process. This value, which is measured in the blood, is used in urology as a tissue marker in order to be able to detect a disease of the prostate at an early stage.
PSA is an indispensable part of urological diagnostics.
During this examination, the examiner's finger is inserted into the patient's rectum to palpate the prostate. The purpose of the investigation is to answer the following questions:
Can the organ be clearly defined?
Has the anatomical shape been preserved?
What is the size?
How is the consistency?
Can the mucous membrane move?
Is the prostate painful on pressure?
During the examination, the tone of the sphincter muscle and the rectum itself are also assessed.
This examination is an ultrasound examination of the prostate. For this purpose, a round-shaped ultrasound head is inserted into the patient's rectum. The examination can be carried out in the lateral position or in the lithotomy position. With the special ultrasound probe, the prostate can be displayed longitudinal and crossways at the same time.
Zones of prostate,
Standard prostate biopsy
Prostate biopsy: tissue samples are taken from the prostate with the help of a special puncture needle. The procedure is carried out on an outpatient basis and under antibiotic protection. By default, we remove 12 tissue cylinders from the prostate according to a standardized scheme. These are sent in for histopathological assessment. The result is usually available after one to two working days.
During the biopsy, the patient is placed in the lithotomy position. The biopsy is performed under ultrasound guidance. After a palpation of the prostate (DRE), the ultrasound probe is inserted into the rectum. Then a local anesthetic is given. While the drug is working, the prostate is assessed using ultrasound (TRUS). Then six tissue cylinders are removed from each of the left and right halves of the prostate.
With a new device, it is possible to detect prostate tumors in a more targeted manner using a tissue sample.
In the Urology Clinic at the Knappschaftskrankenhaus Bottrop, a new device has been available since 10/2017 that can merge the images of a 3-Tesla MRI device with those of a high-end ultrasound device. Special software enables a three-dimensional reconstruction of the prostate, in which the previously marked conspicuous areas can be made visible in their spatial localization. Due to the better detection rate in the MRT examination, conspicuous areas can be mirrored on the conventional real-time ultrasound recordings, so that a millimeter-accurate tissue sample of conspicuous areas in the prostate can be taken. This can significantly improve the detection of malignant prostate tumors.
Samples are taken in cooperation with the Radiology Clinic. There are now specially set up slots for standardized MRI examinations and for the equally standardized biopsy performed under anesthesia. The latter is done in combination with a standard biopsy scheme and is performed through the perineum under anesthesia. This also reduces the risk of infection associated with biopsy.
With the MRT fusion biopsy, we have achieved a decisive improvement in the diagnosis of prostate cancer. This enables us to identify tumors in our patients earlier and treat them earlier.
Before MRT fusion biopsy, a high-resolution MRI examination of the prostate is carried out. Are there areas in the prostate that are suspicious of the presence of prostate cancer, these can be drawn in the images. During the procedure, these images are superimposed - fused - with the live ultrasound images so that these areas can be punctured in a targeted manner during the live examination.
Watchful waiting is no therapy and no control; this procedure is usually used for advanced illnesses and / or very old men and / or other leading illnesses.
Active monitoring can be used for low-risk diseases. As the name suggests, both the clinical findings and the PSA value are checked here at defined time intervals. In addition, imaging procedures and prostate biopsy are used as a control instrument.