Recent developments in early diagnosis for PCa Jochen Walz , Chair EAU Section on Urological Imaging (ESUI)

1. Recent developments in early diagnosis for
Prostate Cancer
Jochen Walz
Institut Paoli-Calmettes Cancer Centre
Marseille/France

2. The history of prostate cancer diagnosis
Digital rectal exam Finger guided
trans rectal biopsy

3. The history of prostate cancer diagnosis
Randomized sextant biopsy
Hodge et al., J Urol 1989; Presti, J Urol 2003; Babaian, J Urol 2000;
Philip, BJU Int. 2004; Eskew, J Urol 1997, etc.
Randomized multicore biopsy

4. Limitations of randomized biopsy
• Unreliable detection
• Need of repeat biopsy when suspicion persists
• Risk of overtreatment
• Need of confirmatory biopsy for active surveillance
Prostate Prostate Prostate

5. Recent developments in early diagnosis
of prostate cancer
Magnet resonance imaging of the prostate

6. Recent developments in early diagnosis
of prostate cancer
MRI of the prostate:
• Independent of chance
• Better detection of disease
• Detection of significant disease
Prostate

7. Recent developments in early diagnosis
of prostate cancer
MRI of the prostate:
• Better characterization of disease
Prostate
Randomized core
Targeted core

8. Prostate cancer management based on
MRI of the prostate
- Improved diagnosis - Less biopsies
- Less overtreatment - Better decision making
- Targeted treatment
Prostate ProstateProstate

9. Limitations of recent developments in early
diagnosis of prostate cancer
MRI of the prostate:
• Costly = 300-1000,-€
• Time consuming = 25-45 min scanning time
• Quality dependant
• Experience dependant
• Standards and quality assurance necessary
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10. Future perspectives:
• Equitable access to high quality MRI
• Reinforce quality assurance of image guided
prostate cancer management
• High quality research evaluating new
technologies that allow image guided
treatment
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