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Making the correct diagnosis
risk of side effects
Why isn't prostate cancer always treated?
It may seem logical to always treat a cancerous tumor – as quickly as possible. But with prostate cancer, it's not so simple.
Surgery, radiation, etc. carry a high risk of side effects such as impotence and urinary leakage. At the same time, prostate cancer is often slow-growing and not always life-threatening. Many men can live their entire lives with their cancer without ever noticing it.
But if the cancer is aggressive, it must be managed to prevent it from spreading!
The degree of aggressiveness of the cancer is therefore the most important factor when deciding whether to have surgery, for example, or whether to wait and follow up.
Gleason – today's analysis method from the 1960s has major limitations
To assess the aggressiveness of the cancer, a specialist doctor, a uropathologist, looks at images of tissue samples. They try to assess the structure of the tissue using a method from the 1960s. The aggressiveness is indicated on a scale of 1 - 5.
The method is so complicated that two doctors can give different answers to the same tissue sample. The fact that the analysis is so difficult and uncertain means that the urologist has to work with margins.
Do I really need surgery?
As a patient, you may be faced with a difficult decision – without having a sure answer.
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Do I really need surgery? - Is the cancer so aggressive that I have to risk impotence and incontinence? 20% of those who undergo surgery today are operated on unnecessarily, "to be on the safe side..."
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Or vice versa. The doctor says we can wait, based on the analysis. Is it certain that my cancer is not aggressive?
What you need is a more secure basis for decisions - we can offer you that!
To reduce uncertainty, a new analysis method has been developed
In the example image, everyone has Gleason 3, but in reality they have different degrees of aggressiveness.
The two left samples have PCAI 23 and 35 respectively, the patient can be actively followed up.
The two on the right have PCAI 76 and 83 respectively and should be treated radically as soon as possible.
PCAI (Prostate Cancer Aggressiveness Index) is an AI-based method developed in collaboration with the Martini Clinic in Hamburg, one of the world's most reputable prostate cancer clinics.
PCAI is based on data from approximately 20,000 patients followed for over 20 years. The result is an accurate and consistent assessment of how aggressive your cancer is.
The advantages of PCAI are:
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Safer and better analysis than the best pathologists – the same biopsy always gets the same answer. (ref, article )
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The answer is given in an index, 1 - 100, compared to today's 1 - 5
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Reassurance for you as a patient – and the best possible decision-making basis for your urologist
This is how an investigation normally goes:
Investigation of suspected prostate cancer
If the PSA value increases over time, MRI Magnetic Resonance Images are taken. The cancer is given a Pi-Rads value (1-5). The norm today is that Pi-Rads ≥ 3 normally motivates continued investigation.
Follow-up can take place, for example, annually or semi-annually, with new PSA tests.
Follow-up
Treatment
Surgery, as well as radiation, carries a risk of side effects such as incontinence and impotence. So if the analysis results show that the cancer is not aggressive enough to justify radical treatment, it is better to wait and follow up.
Surgery etc. (radical treatment) or active follow-up?
The aggressiveness of the tumor is absolutely crucial. Today's traditional method has shortcomings, which leads to unnecessary surgeries "just in case" - or conversely; missed tumors.
PCAI provides a more precise analysis, which helps the urologist make the right choice: safe follow-up or necessary treatment.
Decision
Traditionally, biopsies are analyzed by a pathologist, a specialist doctor. The analysis results provide the degree of aggressiveness. Today's method is imprecise and not reproducible.
PCAI is the alternative modern method for more accurate and reproducible analysis of biopsies.
Analysis
Hollow needles capture tissue samples, biopsies, from the area with the tumor.
Biopsies
MRI
From the age of 50, men should take the PSA blood test regularly.
PSA
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Prostate cancer is the most common cancer in Sweden
About prostate cancer
Prostate cancer is the most common cancer in Sweden. Thanks to early detection, improved follow-up and treatment options, and medications, around 120,000 Swedish men are living with the diagnosis. Every year, around 11,000 men in Sweden are diagnosed with prostate cancer.
The incidence increases sharply with age. More than one in five Swedish men who reach the age of 80 is diagnosed, while the disease is rare before the age of 50. Most men who are diagnosed with prostate cancer have no symptoms of the cancer. Instead, they are diagnosed due to an elevated PSA blood test value in connection with an investigation for benign prostatic hyperplasia or during a health check.
A very large proportion of prostate cancer diagnosed after PSA testing is so-called low-risk or intermediate-risk, with a good prognosis over many years even without treatment. Many men with such prostate cancer should not be treated, but only followed up.
For men who are recommended radical treatment, there are usually several different types of treatment to choose from: surgery, external radiation therapy or internal radiation therapy. For men with low-risk or intermediate-risk prostate cancer, there is no medical urgency to the treatment decision; for some of them, a long time for treatment discussions is valuable.
Patients with an aggressive cancer, which is not treated, are at risk of mortality within 5–10 years of diagnosis.
Most men with high-risk cancer can be treated with either surgery, radiation therapy, hormonal therapy, focal therapy, or a combination of these. Patients need to discuss their treatment with both a urological surgeon and an oncologist, who will administer the radiation.
Prostate cancer with confirmed spread is treated medically with hormonal drugs or surgically. In cases of limited spread, local radiation therapy to the prostate tumor may be appropriate.
Source: Vårdprogrammet
How does the pathologist assess the sample?
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In a laboratory, thin sections of the tissue sample are cut and placed on glass slides. These sections are stained to highlight different cell structures, making it easier to see any abnormal cells. The slides are digitized in a scanner and magnified 200 times.
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The pathologist analyzes the shape, size, and arrangement of the glands. Abnormalities may indicate cancer.
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A cancer is classified by the pathologist and given a degree of aggressiveness. The norm today is a Gleason grade, 1 - 5. The sum of the two most significant areas forms a value. 3+3 for example is then ISUP (International Society of Uro Pathologists) group 1.
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ISUP 1 is considered non-aggressive, these patients are followed up.
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ISUP 2 (3 + 4) here is considered whether radical treatment is required now or if the patient can wait and be followed up.
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ISUP 3 (4 + 3) and ISUP 4 and 5, are considered aggressive, radical treatment necessary.
How reliable is the Gleason analysis?
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Accuracy: The Gleason method dates back to the 1960s, but with modern techniques and experienced staff, most pathological analyses are reliable. Studies show that errors can occur, especially in early stages of the disease or in difficult diagnoses.
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Inter-subjectivity: Different pathologists may reach different conclusions, especially in borderline cases. In some cases, a second opinion from another pathologist may be valuable to confirm the results.
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Follow-up and additional tests: In some cases, additional tests or follow-ups are recommended to ensure a correct diagnosis and assessment.
The analysis of the biopsies is the most important factor in choosing the next step
The urologist's recommendation is based partly on your data, such as age, your PSA value, T-stage and PI-RADS value (Prostate Imaging–Reporting and Data System), from MRI, (Magnetic Resonance Imaging). The most important decision factor is the analysis of your biopsies, tissue samples; how aggressive is the cancer? This has been done in a "first opinion" using the Gleason method, where the analysis results in a value of 1 - 5. It is a pathologist who has made an assessment of which category your cancer falls into, a mild variant, Gleason 1, or an aggressive one, Gleason 5. The method is complicated and the grading can differ between different pathologists. This means that two pathologists can come to different assessments of a patient.
PCAI, a new analysis tool
With our Second Opinion method, the assessment has been made – as above, based on your data – but with an analysis method that is based on how a large number of patients have fared.
This means that your biopsy images have been compared to patients whose outcomes are known to PCAI. Your biopsies are therefore similar to a population of patients in the database who have had a cancer development that justifies the recommendation you received in your Second Opinion.
