Prostate Cancer : the work-up

Prostate Biopsies

When prostate biopsies have discovered prostate cancer, the diagnosis is formally stated. It is therefore not necessary to redo biopsies to confirm diagnosis.

Vital/valuable information is gathered from the knowledge of the number of positive biopsies in relation to the total number of biopsies carried out, often 12, and the length where the cancerous tissues is shown relative to the total length of each biposy.

The Gleason Score

One of the most vital pieces of information in regards to prognosis is the estimation of the degree of differentiation of the tumour, judged by the Gleason Score rated on a scale of 4-10.
Well differentiated tumours develop slowly unlike undifferentiated tumours (Gleason Score 8-10).
Tumours moderately differentiated have an intermediary prognosis in regards to those previously discussed.

Prostate Specific Antigen (PSA)

All such information, correlated to the rate of the Prostate Specific Antigen (PSA) at the moment of diagnosis, alongside the information from rectal touch and the age of the patient, enables the urologist at this stage to give a prognosis and inference if the prostate cancer is localised.

To make sure that the cancer is well confined to the inside of the prostate and that it has not exceeded the capsule, or that its range does not extend to the ganglions or the bones, is indeed the critical element in the choice of treatment, in particular for patients above the age of 75.

Developmental stages of prostate Cancer

It is in fact localised cancers, intracapsular, diagnosed early that can undergo a curative treatment capable of curing the patient.

Stage T1 shown here is a small chance discovery of cancer on biopsies prompted by a rise in PSA.

Stage T2 corresponds to cancer perceived upon rectal touch, extensive, touching the 2 lobes of the prostate, but still limited to the gland, intracapsular.

Stage T3 corresponds to a locally advanced cancer, crossing the capsule, invading the seminal vesicles.

Stage T4 corresponds to a fixed voluminous cancer, invading neighbouring organs like the rectum, and accompanied by bone metastases (pubis) and ganglion/lymph nodes.

Further investigations are needed to clarify the extent of the tumour.

The magnetic resonance imaging (MRI)

A chest radiograph is simple to implement. The magnetic resonance imaging (MRI) of the prostate is useful in specifying the topography of the tumour, the status of the prostatic capsule, the seminal vesicle and the pelvic ganglions/pelvic lymph nodes.

As with endo-rectal echography cancer cannot be visualised or is visualised incompletely with this method, due to this day, an ideal imaging exam for the study of prostate cancer does not exist.

Pulmonary Radiography and prostatic MRI are usually sufficient in assessing the extent of prostatic cancer.
In some cases especially when PSA at diagnosis is superior to 15ng/ml., a bone scintigraphy is necessary to search for the dissemination of bone/osseous metastasis.

Computed tomography (CT) is not a good examination for the study of prostatic tissue, though it can provide information on the status of the ganglions/lymph nodes, this is usually ascertained with the MRI.