Latest innovations in the Diagnosis and Staging of Prostate Cancer | ASSOCIATE PROF. CENK ACAR
Latest innovations in the Diagnosis and Staging of Prostate Cancer

Prostate cancer is diagnosed by prostate biopsy with rectal ultrasound in patients with high Prostate-Specific Antigen (PSA) level and/or abnormal findings in physical examination. The use of less painful biopsy techniques with high-resolution ultrasound technology and magnetic resonance imaging (MRI) increases the diagnostic accuracy and patient’s comfort. An important development in staging of prostate cancer is the ability to determine the spread of the disease outside the prostate and lymph glands by using multiparametric data on MRI. Additionally, the studies emphasized that whole body MRI is significantly superior to other imaging tchniques such as bone scintigraphy or computerized tomography carried out in pre- and post-treatment periods.

Surgery and radiotherapy are the most commonly used treatment options for patients that cancer is localized in the prostate. However, tumor spread to the prostate neighborhood and lymph glands are found in the postoperative period in 35-45% of patients. Determining this situation before operation or removing the lymph nodes surrounding the prostate during the procedure (open or robotic surgery) in patients with medium-high risk will change the treatment plan particularly and can affect the survival of the patients.

Showing the spread to the lymph glands definitely can only be possible with removing all the lymph glands surrounding the prostate during the procedure. However, this procedure brings forth some postoperative complications. Unfortunately, some surgeons avoid removing the lymph nodes completely in order not to confront such situations and terminate the procedure after collecting a few samples. In the recent years however, whapping developments were shown in this area, and finding the lymph node that cancer had spread first and removing it with the help of robotic assistant and laparoscopic prostate cancer surgery would suffice for diagnosis. We called this lymph nodes as “Sentinel Lymph Node”. This method that allows identification of the sentinel lymph node seen with a green fluorescence in near infrared light after the injection of a substance named indocyanine green (ICG) during operation. It has become the most popular subject matter of the congresses held within the last 1-2 years. It has been shown that determining the lymph node involvement increases by 20% if applied together with complete removal of lymph nodes.