Prostate Cancer Center

About Prostate Cancer Center

The Prostate-Center is part of the Prof. Dr. Stehling Institute for Diagostic Imaging. It was founded in 2010 by Prof. Michael K. Stehling. At the Prostate-Center physicians, scientists and engineers collaborate closely. One goal is the further development of minimally-invasive diagnostic techniques and therapies for diseases of the prostate and to make them available for the treatment of patients.

Prostate cancer (PCa) constitutes one of the greatest challenges in medical care of men. With 25 % of all cancers, prostate cancer is the most frequent malignant tumour in men and responsible for 10 % of all cancer deaths.

Currently established treatment methods for prostate cancer are invasive an in many cases impair the quality of life of the afflicted men through impotence and incontinence.

At the same time, many prostate cancers do not have to be treated at all, because they remain confined to the prostate gland, causing neither symptoms nor leading to death.

A paradigm change in the treatment of prostate cancer is thus necessary: Instead of a radical therapy with massive side effects a minimally-invasive therapy without or with only minimal side effects should be employed. As long as the spread of the cancer in the body is prevented, the therapy is successful.

At the Prostate-Center we thus employ the most advanced methods for the diagnosis and therapy of prostate cancer. In our effort, two goals are paramount: Survival and quality of life.

To achieve this, we are have established a close interdisciplinary collaboration with Urologists, Pathologists, Radiologist, Anaesthesiologists and Scientists from different countries in Europe, USA and Asia. Continuous innovation and the highest possible degree of competence are thus guaranteed.

Neutral colors, discreet lighting and simple design invite all our patients to spend a stress-free and comfortable time with us.

These are the elements used throughout the practice including in our treatment rooms: our specially designed MRI examinations rooms provide patients with natural lighting and an outside view of the scenery outside our offices.

Our open MRI machine and large window help to avoid the feeling of suffocation or claustrophobia.

Come and see yourself!

Call us now to schedule an appointment and meet our team of trained experts in a calm and relaxing atmosphere as you learn about and consider the best treatment options that are right for you and your individual needs and concerns.

Our Treatments

Which treatment is chosen for which patient depends on many factors: Besides the tumor stage and grade the choice is also influenced by the patient’s age and health, but also by personal preferences.

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When the carcinoma is confined to the prostate, a focal treatment method which focuses on the prostate can be chosen.

The current routine focal treatment method is the surgical removal of the prostate (radical prostatectomy), also with robotically-assisted surgery (so-called Da Vinci Surgery). Other treatment methods comprise brachytherapy (internal radiation treatment through implanted radioactive seeds) or external radiation therapy.

All these radical methods, however, have severe side effects and result in erectile impotence in the majority of patients and cause urinary incontinence in up to 50%.

Thermal methods like focused ultrasound (HIFU) cryotherapy still have vast side effects and frequent reoccurrences.

When the cancer has spread beyond the capsule, hormone therapy (blockade of male sexual hormones) or external radiation therapy constitute the primary choices for treatment. Such treatments have also adverse side effects.

Focal therapy of prostate cancer with the NanoKnife (irreversible electroporation) allows the selective destruction of cancer cells in those areas of the prostate, which harbour the cancer – with only minimal damage to healthy parts of the prostate.

Important structures of the prostate such as vessels and nerves, the base of the bladder, the urinary sphincter and the bowel, remain intact. Contrary to other treatment methods impotence and incontinence can thus be avoided, likewise wound pain and scar formation.

Treatment is complete within 24 hours. Rehabilitation and after-care are not necessary.

In advanced cases of prostate cancer, the NanoKnife treatment can be complemented with a cyberknife treatment.

What is Prostate Cancer?

Prostate cancer is a form of cancer that develops in the prostate (gland of the male reproductive system).

Prostate cancer occurs when cells in the prostate gland grow out of control and the ability to regulate cell growth or death is lost. The enlargement of extra cells forms a mass of tissue called a growth or tumor.

Actually, it is one of the most common cancer forms, affecting 1 in 6 men.

Prostate growths can be divided into two groups:

Benign (not cancer), such as Benign prostatic hyperplasia (BPH), enlarged prostate or prostatitis, which according to a common belief may lead over time to the development of prostate cancer.

And

Malignant (cancer) tumors. As opposed to benign it:

• May be threat to life
• Often can be removed, but sometimes grow back
• Can invade and damage tissues and organs nearby
• Can spread to other parts of the body, causing metastasis

Prostate Cancer Symptoms

Not every patient has symptoms of prostate cancer and the first signs of prostate cancer are first detected by a doctor during the check-up or diagnostic.

Some patients can have an experience with changes in urinary or sexual function which might indicate the presence of prostate cancer. These symptoms include, for example:

• A need to frequently urination (especially at night)
• Difficulty to start urinate or to hold back the urine
• Flow of urine is weak or interrupted
• Painful or burning urination
• Difficulty in having an erection
• Ejaculation is painful
• Blood in urine or semen

Early Detection and Prevention of

Prostate Cancer

As every untreated and allowed to grow, malignant cells from cancerous tumors can spread and cause metastasis in other part of the body. If it happens, the chances to treat the disease successfully much lower.

The early detection of the cancer cells plays here the utmost important role.

Screening for prostate cancer usually comprises blood testing for PSA (prostate-specific antigen) and a digital rectal exam of the prostate gland. Whilst easy to perform and cheap, prostate cancer can be missed by these tests. On the other hand “false positive” findings can mimick cancer, albeit being benign changes of no importance.

Thanks to new developments in this filed, the identification of the precancerous prostate tumors can be found in much earlier stages and hence leaving the patient more gentle treatment options and a higher chance of survival.

Multiparametric MRI-Scans, Cholin-PET scans, MRI-Guided 3d-Biopsies are advanced tools giving rise to a new era of prostate cancer treatment.

Prostate Cancer: Screening and Diagnosis

When I should make a screening?

Prostate cancer occurs with increasing frequency, even in younger men. Contrary to benign prostatic hypertrophy (BPH) or prostatitis most prostate cancers do not cause any symptoms and are visible when it is too late.

Therefore, annual prostate cancer screening is recommended for men aged 50 or above. For patients who have first degree relatives with prostate cancer, screening should commence at the age of 40.

Routine screening is not accurate enough

Screening for prostate cancer usually comprises blood testing for PSA (prostate-specific antigen) and a digital rectal exam of the prostate gland. Whilst easy to perform and cheap, prostate cancer can be missed by these tests. On the other hand “false positive” findings can mimic cancer, albeit being benign changes of no importance.

Percentage of men harboring a prostate cancer (PC) as a function of the PSA-level. Whilst in Germany a biopsy is recommended with PSA > 4 ng/ml, in the US the threshold for biopsy is 2.5 ng/ml.

Ordinary biopsy defines the diagnosis only in up to 35% of cases. MRI-Guided 3d-Biopsies are much more precise, have a much lower infection rate and are absolutely necessary for every modern focal treatment.

“Biopsy-Free” Diagnostic of the Prostate

More Accurate and Safe

As an alternative to a biopsy a non-invasive (“biopsy-free”) diagnostic work-up can be chosen initially, employing endorectal magnetic resonance imaging (MRI) and spectroscopy (MSR).

Advantages of the “Biopsy-Free”-Diagnostic:

• These methods afford accuracy for the detection of prostate cancer of 80 % and above.
• Further, they provide information about the location of a potential carcinoma in the prostate, such that a subsequent biopsy can be carried out more accurately.

Multi-parametric MR Imaging Diagnostic

Most Accurate Imaging Technique for Prostate Cancer Detection

Contrary to other imaging techniques (Computed tomography, ultrasound imaging, szintigraphy, positron emission tomography) MRI provides multiple mutually independent parameters for the assessment of the prostate:

• T1- and T2-relaxation time
• Tissue susceptibility
• Water diffusion
• Tissue perfusion and
• Spectroscopic information about metabolism.

Due to this, MRI is superior to other imaging techniques such as ultrasound and also when compared to elastography.

The four pillars of multi-modal MRI diagnostics of prostate cancer: Imaging, diffusion, perfusion and spectroscopy.

Also the analysis of the chemical composition of prostatic tissue makes the diagnostic with MSR (MR-Spectroscopy) so precise and valuable.

Prostate spectroscopy depicts the chemical make-up of prostatic cells. Healthy cells contain large amounts of citrate and little cholin. Cancer cells contain less citrate, which is metabolised for the generation of energy, and more cholin, which is needed for the assembly of the cell membranes in the tumour cells.

Our Treatment of Prostate Cancer

Precise and Safe

Step 1: Diagnostics

Specifying the Target with Transperineal 3D-Biopsy of the Prostate: Pain-free – Safe – Precise

Pain-Free and Safe

Transperineal biopsy is carried out pain-free in full anaesthesia, and steril under operation room conditions such that the risk of a post biopsy infection of the prostate (prostatitis) is negligible.

Precise

The highest accuracy is achieved with transperineal (through the skin of the pelvic floor) 3D-biopsy, which affords a detection rate for prostate cancer between 75 and 100 %.

A 3D biopsy is carried out ultrasound-guided with the aid of a “stepper” and “grid”.

The MRI data give additional insight and allow a precise planning. Also the results of the biopsy can be displayed within the MRI pictures so that a very precise treatment planning is possible.

This particular method makes it possible to sample tissue from the whole prostate in well-defined locations.

This way, a three-dimensional tissue map can be assembled, which reveals whether a prostate cancer is confined to a specific location in the prostate (focal) or distributed over an extended volume (multi-focal).

In advanced cases a whole body MRI determines the stage of the cancer by looking for possible metastasis.

Advantages of the 3D-Biopsy: 3D-Biopsy vs. usual Biopsy

• The more examples are taken (about 60 in 3D-Biopsy against 12 in regular Biopsy), the more precise the carcinoma can be located.

• The biopsy is MRI guided, hence it is precise and highly accurate in all three dimensions.

• Knowledge of this is a prerequisite for further therapy planning.

• Transperianeal 3D-Biopsie Affords Gentle, Minimally-Invasive Focal Therapy with Nanoknife of Prostate Cancer

• Based on the information about the exact special distribution of a cancer in the prostate a selective focal treatment can be carried out.

• This way only those regions of the prostate affected by cancer are destroyed.

• Healthy regions of the prostate can be preserved.

MRI scans of the prostate before (left) and after (right) 3D-biopsy with an average of 60 samples.

Step 2:

Therapy with the NanoKnife and the CyberKnife

Nanoknife is a novel promising method for the selective destruction of tumor cells by strong local electric fields. Affected by the electric fields of several thousand volts cell membranes are opened up until the cell ruptures. This process corresponds to an induced apoptosis (natural cell death).

?Non-cellular tissue components are not damaged by the NanoKnife-Treatment. The tissue matrix, which is made up of collagen and elastin fibres, proteoglycans, etc., remains fully preserved. Because blood and lymphatic vessels as well as the urethra, besides cells, have an extensive and stable tissue matrix, they regenerate fully: The destroyed cells re-colonise along the matrix.

?Other treatment methods, which destroy all tissue elements, induce a tissue necrosis (coagulation of all tissue components). This necrosis is eventually removed over the course of many months by an inflammatory process encompassing the necrosis. This process causes inflammatory pain and, after healing of the necrosis, scarring, which can severely hamper subsequent treatments.

?NanoKnife or Irreversible Electroporation, on the contrary, does not induce any tissue necrosis and consequently no inflammation. Treatment with the NanoKnife thus avoids pain and scarring. Because blood vessels and tissue perfusion are preserved the dead cell’s debris is removed quickly from the treatment zone.

If the prostate cancer has spread, the metastasis can an many cases be treated with a Cyberknife system.

The Cyberknife system is a computer operated robot - guided radiation therapy approach which allows a very precise radiation deployment, even more precise than proton therapy.

Outline of the 3D-Biopsy-Work-Up and Nanoknife-Treatment

Step 1: Preparation for the Treatment -3D-Biopsy-Work-Up

1 Day: Localisation of the tumor cells with 3D-Biopsy-Work-Up?2 Day: Histological investigation and MRI-Control

Step 2: Nanoknife Treatment

3 Day: Prostate Cancer Nanoknife Treatment?4 Day: MRI-Control and Discharge from the hospital

• The treatment costs include:
• Consultation with the doctors
• Nanoknife Treatment
• Anesthesia
• One night hospital stay
• MRI-Control of the pelvis next day

Experience and Commitment

In the center of the Rhine-Main area, the diagnostic imaging in alpha-house in May 2005 phil under the direction of Prof. Dr. Dr.. Dr. med. Michael K. Stehling continued at a new site. Following on from his experience at Harvard Medical School and the long-standing collaboration with the Nobel Prize in Medicine in 2003, Sir Peter Mansfield sets, Prof. Stehling here continues its commitment to health care and a precise and gentle early detection of diseases.

The team of diagnostic imaging experts with years of experience in treating their fields after the state of the science. They are guided by international standards of diagnosis and treatment as well as to the guidelines of leading hospitals, medical societies and government institutions.
 

Far Ahead to Knowledge and Technology

 For you as a patient, this will require high medical expertise and use of the latest high-tech methods. Personal service and friendly atmosphere complete our performance for you. Our tight integration with a network of specialists also your follow-up is also on the investigation into the diagnostic imaging in good hands.
 

Our Physicians

Prof. Dr. phil. Dr. med. Michael K. Stehling
Director of the Institute, Head of Research and Development

Dr. Michael K. Stehling is Adjunct Professor at the Ludwig-Maximilians University (LMU) in Munich and Associate Professor of Radiology at Boston University in Massachusetts, USA.

After completing his studies in Human Sciences and Medical Physics at the University of Manchester, England and the Johann-Wolfgang-Goethe University in Frankfurt, Germany Dr. Stehling served as Research Assistant to Sir Peter Mansfield, Prof of Physics and Nobel Prize winner in Medicine in 2003 (for discoveries concerning magnetic resonance imaging) and thereafter completed doctorate work in echo-planar imaging.

He completed his radiology training at the University Hospital in Zurich, Switzerland and was later Resident and Clinical Fellow in Radiology at the Beth Israel Hospital at Harvard Medical School in Boston, MA, USA.  During this time he also worked with Siemens AG in Erlangen in their Research and Development department.

Prior to founding and starting the Institut fur Bildgebende Diagnostik in Frankfurt/Offenbach in 2005, Dr. Stehling served as Senior Physician and Director of the Radiology department in the Radiology Institute at the Ludwig-Maximilians Unversities, Grosshadern Clinic.  During this time he completed his qualification as an Adjunct Professor and gave regular lectures at LMU.

Since 2009 he has been Associate Professor of Radiology at the Boston Univeristy School of Medicince, Department of Radiology.

He is a member of the German Radiological Society, the Radiological Society of North America and the International Society for Magnetic Resonance in Medicine.

Dr. Stephen Zapf
Deputy Director, Head of cross-sectional imaging and micro-therapy.

Dr. Kirsten Holsteg
Line Womens Imaging and MRI breast center

Dr. Cristian Rodriguez
Physician, researcher

Prostate Cancer Center

Prostate Cancer Center

Prostate Cancer Center