The prostate is a small gland found only in men, roughly the size and shape of a chestnut. It was named by Herophilus, a Greek physician from Alexandria who lived in the 3rd century BC, because it “stands before” (proïstatai), meaning that it is located in front of the urinary bladder and surrounds the initial part of the urethra.
Its main function is to produce a fluid that forms part of semen, providing nutrients and substances necessary for sperm vitality. Due to its location, enlargement of the prostate may put pressure on the urethra, causing difficulties with urination.
Prostate Cancer
Prostate cancer is the most common cancer among men in the Western world and the second leading cause of cancer-related death, after lung cancer. One in six men will be diagnosed with prostate cancer during their lifetime, with the average age at diagnosis being 66.
Men who have a first-degree blood relative (father, uncle or brother) with prostate cancer have 2.4 times higher chances of developing the disease compared with other men. Prostate cancer in its early stages is usually asymptomatic. It is generally slow-growing and, when diagnosed at an early stage, can be treated effectively. However, the 5-year survival rate is 98.9%.
Clinical Forms
Prostate cancer varies considerably in terms of aggressiveness. There are two broad forms:
- a theoretically “indolent” form, which may not affect the patient’s survival or quality of life;
- a more “aggressive” form, which may progress rapidly and become painful and life-threatening.
Diagnostic Approach to the Prostate Gland
The established screening approach for prostate cancer has traditionally included two examinations:
- Measurement of prostate-specific antigen (PSA)
- Digital rectal examination (DRE)
In particular, when PSA levels fluctuate or show a progressive increase, further evaluation with multiparametric magnetic resonance imaging of the prostate (mpMRI) is recommended to investigate the possibility of a neoplastic lesion.
Multiparametric Magnetic Resonance Imaging (mpMRI) of the Prostate
Multiparametric magnetic resonance imaging (mpMRI) of the prostate is an advanced, non-invasive imaging examination that combines different MRI sequences to provide detailed visualization of the prostate. The examination is primarily used for the accurate detection, staging and monitoring of prostate cancer, providing both anatomical and functional information. It may help avoid unnecessary biopsies or guide targeted biopsies when indicated. It is a safe and non-invasive procedure, without the use of ionizing radiation, and provides high diagnostic accuracy in detecting and characterizing suspicious lesions. The examination is performed using modern MRI scanners. The patient lies in a supine position, and the examination typically lasts approximately 20–30 minutes.
mpMRI combines:
- T2-weighted sequences, which provide detailed anatomical information;
- Diffusion-weighted imaging (DWI), which provides functional information related to tissue cellularity;
- Dynamic contrast-enhanced (DCE) imaging, which provides information regarding tissue vascularity.
The advanced technology available at the diagnostic centers of Euromedica, combined with the expertise of its specialized medical and paramedical staff, enables the provision of high-quality diagnostic services and establishes new standards in prostate imaging. Particular emphasis should be placed on the importance of using a high-field 3 Tesla (3T) MRI scanner for optimizing the diagnostic quality of the examination. High-field MRI scanners, such as the one used at the Euromedica Alexandroupoli Diagnostic Center, provide high-quality imaging of the region of interest, while the information obtained from diffusion-weighted sequences is more detailed and accurate.
Following completion of the examination, the specialized radiologist evaluates the areas of interest according to the likelihood of clinically significant prostate cancer, using the PI-RADS (Prostate Imaging Reporting and Data System) classification.
The PI-RADS scale ranges from 1 to 5 and indicates the likelihood of clinically significant prostate cancer:
- PI-RADS 1 (Very Low): Clinically significant cancer is highly unlikely to be present.
- PI-RADS 2 (Low): Clinically significant cancer is unlikely to be present.
- PI-RADS 3 (Intermediate): The presence of clinically significant cancer is equivocal, meaning that it cannot be determined with certainty.
- PI-RADS 4 (High): Clinically significant cancer is likely to be present.
- PI-RADS 5 (Very High): Clinically significant cancer is highly likely to be present.
Multiparametric magnetic resonance imaging (mpMRI) of the prostate can help avoid unnecessary biopsies, as the examination can identify and characterize suspicious areas with a high degree of accuracy.
It can also contribute to the planning of personalized treatment and the monitoring of the patient’s response to treatment. mpMRI may detect local recurrence following radiotherapy or brachytherapy. This is particularly useful because changes in PSA levels during early recurrence are non-specific. It may also detect local recurrence following radical prostatectomy and assist in guiding radiation therapy. It should not be forgotten that, as with any imaging examination, the quality of the imaging equipment is important. However, equally—and often critically—important are the experience of the radiologist and the careful interpretation of the findings.
At Euromedica, we combine both. We provide you with the tools to take care of yourself and your loved ones, with the reliability of one of the largest healthcare providers in Greece.
The wise Hippocrates said: “Prevention is better than cure.”
Nikolaos Kourkoutsakis
Professor of Radiology – Democritus University of Thrace
Scientific Collaborator at Euromedica Alexandroupolis