HistoScanning is a diagnostic imaging technique based on ultrasound examination that urologists have been using since 2008 to detect areas of the prostate suspected to be cancerous, which are then targeted for biopsy. Confirmation of initial suspicion is provided exclusively by biopsy.
What is HistoScanning?
HistoScanning is a diagnostic imaging technique based on ultrasound examination that urologists have been using since 2008 to detect areas of the prostate that are suspected to be cancerous. HistoScanning is an innovative procedure for diagnosing tumor sites in the prostate. The term includes the word “histology“. This is a branch of medicine, more specifically pathology and anatomy. It is the science of biological tissue. Traditional histology examines microscopic tissue sections using staining techniques. This is where HistoScanning comes in. Using a three-dimensional ultrasound examination, areas suspected of containing tumors are marked in color by computer-assisted analysis. This modern and innovative data processing improves the information content of the classic ultrasound technique and goes far beyond the level of the regular grayscale technique. The examination provides information on the spread, localization and number of tumor foci. The result is a consecutive increased detection rate of tumor-suspicious areas by perineal prostate biopsy. By using ultrasound-guided needle guidance with a reduced number of biopsy cylinders, this method enables targeted carcinoma detection. HistoScanning has increased the importance of imaging diagnosis of clinical tumor stage in recent years.
Function, effect, and goals
Prostate cancer is the most common type of tumor in men and the second leading cause of death from disease in men in industrialized nations. An elevated PSA level compels urologists to perform a workup in the form of a biopsy, because this value indicates a malignant change in the activity of prostate tissue. HistoScanning evaluates the raw data from a rectal and conventional ultrasound examination with the aid of a computer. With this data, urologists are able to accurately visualize, differentiate and size altered and cancerous prostate tissue. Carcinoma-like tissue is color-coded using this data by differences in ultrasound behavior and differentiated from benign (healthy) tissue. The special feature of this examination method is the color marking by patented algorithms, which makes the visualization of the pathologically changed tissue possible in the first place. This visualization is lost in the classical ultrasound examination in the “general gray procedure”. The examination is performed through the rectum and takes fifteen minutes. A filigree ultrasound probe is inserted into the rectum to get as close as possible to the prostate. This probe is attached by a magnet to a motor that rotates the small device on its axis while it captures high-resolution, 3-D quality images and performs up to three scans. The examination is painless, but can be somewhat uncomfortable for the patient. The images are taken using 3-D technology and the prostate is displayed in three dimensions. After manual processing of the computer image, the evaluation is performed by patented algorithms. With this method, the physician is independent in his examination, as he evaluates the computer-generated data directly afterwards. If the initial suspicion of prostate cancer is confirmed, the urologist is able to determine the number of tumor areas in the prostate gland with a high degree of accuracy. HistoScanning enables targeted prostate biopsy and improved planning of local therapy in cases where prostate cancer has been diagnosed with certainty, in order to achieve sparing of the neurovascular structures. With biopsy, the likelihood of hitting the areas suspected of tumor increases to reduce follow-up biopsies. Critical colleagues accuse urologists of performing too many unnecessary biopsies. This ultrasound-based diagnostic procedure helps determine the cause of the elevated PSA and, if positive, focus on the suspicious area to avoid negative biopsies. It helps the urologist decide on the number of biopsy cylinders to be taken. The standard number of tissue cylinders in a prostate biopsy has decreased significantly in recent years.Whereas fifteen years ago six cylinders were considered the standard, nowadays 12 to 14 biopsies are taken in a fixed scheme during one session. This positively decreased standard reduces the risk of this procedure, which increases with frequency.
Risks, side effects, and hazards
HistoScanning poses no risk to the patient because it is a noninvasive examination method. The distinctive feature of this method is an almost one hundred percent agreement of the HistoScan results with the results of the subsequent fine tissue examination of the prostate tissue. This imaging examination method offers previously unknown methods of active surveillance of detected tumor sites, because not every prostate cancer necessarily has to be surgically removed. The special ultrasound examination enables physicians to assess whether the detected tumor focus is growing and how close it is to the prostate capsule (organ boundary). Based on this information, the urologist assesses whether the wait-and-see strategy used so far is still justified or whether other treatment options are indicated. HistoScanning is also available in combination with other screening tests to guarantee the interested man the greatest possible diagnostic certainty without lengthy and unpleasant examinations. Although surgical removal of prostate carcinoma is still the “gold standard”, the focus is increasingly shifting to the patient’s postoperative quality of life in addition to tumor control. This includes the preservation of continence and potency. The aim of HistoScanning is to realize this wish of patients and urologists. If the physician detects no suspicious malignant structures, the vascular and nerve pathways running along the two outer sides of the prostate capsule are spared without limiting the radicality of the surgical procedure. Furthermore, with this examination the urologist pursues the goal of significantly reducing the number of biopsies. Members of statutory health insurance companies pay for this examination themselves, as it is a self-pay service. Private health insurance companies usually cover the costs of the examination after application.
