From Diagnostic Testing to Therapy

Our range of services and consultations

What tests are necessary?

From the beginning, we counsel you about diagnostic and therapeutic procedures. For benign enlargement as well as cancer of the prostate, certain tests are required before initiating therapy. To avoid duplicate examinations, we only perform those tests that have not been performed by the primary care doctor or urologist.

 

An overview of testing methods:

  • Digital rectal examination
  • Prostate-specific antigen (PSA)
  • Transrectal/transvesical ultrasound of the prostate
  • Punch biopsy of the prostate with DNA analysis
  • Ultrasound of the kidneys and residual urine
  • Uroflow (urinary flow measurement)
  • International Prostate Symptom Score (IPSS questionnaire)
  • Bladder examination (urethrocystoscopy)
  • Excretory urography
  • Ancillary diagnostics
  • Computer tomography (CT)

 

Digital rectal examination

In a digital rectal examination, the doctor palpates the prostate with his finger through the rectum. Since the prostate is located directly in front of the rectum, palpation can provide information about the size and consistency of the prostate gland. Suspicion for prostate cancer arises, for example, if areas of hardening or “wooden” consistency are palpated.

 

Prostate-specific antigen (PSA)

Blood testing to measure the level of prostate-specific antigen (PSA) is a procedure with good diagnostic value. Elevation of the PSA level suggests the increased likelihood of prostate cancer. However, an enlarged prostate gland or inflammation of the prostate may also cause elevated PSA levels. Therefore, to confirm the diagnosis or rule out prostate cancer, tissue samples are obtained from the prostate. This takes place through what is known as a prostate punch biopsy (see below). Determination of PSA levels has additional value later on for monitoring progress after initiating therapy.

 

Transrectal / transvesical ultrasound of the prostate

In a transrectal ultrasound (TRUS), a high-resolution ultrasound probe is inserted in the rectum. The close proximity between the rectum and the prostate enables assessment of the prostatic tissue with ultrasound and detection of areas within the prostate that are suspicious for cancer as well as measurement of prostatic size. Further, this examination provides an indication of whether a prostate carcinoma that may be present is confined to the prostate gland. In addition to the ultrasound examination via the rectum, the prostate can also be visualised using a transvesical ultrasound. For this test, the ultrasound probe is placed on the lower abdomen. However, transrectal ultrasound gives more reliable results and is thus preferred.

 

Punch biopsy of the prostate (TRUS with PE)

As part of a transrectal ultrasound examination, tissue samples are obtained from the prostate through the rectum using a fine needle. This test is almost pain-free but can be performed under either local or general anaesthesia. The tissue obtained is then examined for cancer cells by a pathologist. If a prostate carcinoma is detected, it is rated according to an international classification system, the Gleason score. The Gleason score is the most important and prevalent classification system for prostate cancer.

 

Fine needle biopsy of the prostate with DNA analysis

By means of a fine needle biopsy with a DNA analysis in addition to the Gleason score, it is possible to determine whether a documented tumour is highly aggressive or less dangerous. This test gives the patient and the therapist additional information for decision-making regarding the most appropriate therapy.

 

Ultrasound of the kidneys and residual urine

An ultrasound examination of the kidneys provides an indication about the presence of urinary stasis, that is, an obstruction to the outflow of urine from the kidneys caused by an enlarged prostate. In addition, the determination of residual urine via ultrasound is a painless, simple and rapid way to test bladder emptying.

 

Uroflow (urinary flow measurement)

Urinary stream measurement is a simple and painless test. It helps determine the strength of the maximum urinary stream and of the amount of urine the bladder can hold.

 

International Prostate Symptom Score (IPSS questionnaire)

This standardised questionnaire documents the patient’s symptoms with respect to weakening of the urinary stream, frequent and nocturnal urination, feelings of residual urine and increased urinary urgency. It makes sense for the patient to complete this questionnaire before, during, and after therapy to help monitor the course of the therapy.

 

Urethrocystoscopy

Cystoscopy may be necessary to rule out a bladder tumour and to gain information about the urethra and prostate.

 

Excretory urography

This is a radiological procedure to examine the flow of urine from the kidneys using a contrast agent. It yields information about the status and function of the urinary tract.

 

Ancillary diagnostic testing

In a few cases, additional tests may be required to determine a patient’s optimal therapy. Basically, such ancillary diagnostic testing involves two examinations that can be performed on an outpatient basis and provide relevant information about the extent of the tumour.

 

Bone scan

This nuclear medicine bone test can detect metastases in the bones. Currently, it is recommended to perform this test in the case of PSA levels above 20 ng/ml.

 

Computer tomography (CT)

This examination procedure may be used to determine whether a prostate cancer has already spread beyond the prostate gland or into the lymph nodes.

 

We want to provide you with complete information

The question of ‘how’ is more critical in selecting a treatment than the question of ‘when’. The best decision is one made by a fully informed patient who can decide with complete conviction. Alongside providing treatment of the highest quality, well informed decision-making is our most important goal.