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Review
. 2019 Apr;6(2):129-136.
doi: 10.1016/j.ajur.2018.11.007. Epub 2019 Feb 14.

Diagnosis of prostate cancer

Jean-Luc Descotes  1
Affiliations
Review

Diagnosis of prostate cancer

Jean-Luc Descotes. Asian J Urol. 2019 Apr.

Abstract

Diagnosis of prostate cancer (PCa) and adequate staging play a fundamental role for clinical and patient care. Despite major advances in biology and imaging, rectal examination and prostate-specific antigen (PSA) blood test remain the cornerstone for screening, and multiparametricmagnetic resonance imaging (mpMRI) for local staging. Recent advances in mpMRI lead to standardised interpretation and increased prescription by clinicians in order to improve detection of clinically significant PCa and select patients requiring targeted biopsies. However its indication remains controversial in biopsy-naïve patients. Nuclear medicine is also in a continuous evolution and utilisation of new radiopharmaceutical agent like choline or 68gallium with computed tomography or magnetic resonance imaging has led to the improvement in the detection of lymph nodes, distant metastases and prostate recurrence. Considering this very heterogneneous disease, combined utilisation of these tools will help clinicians and patients in choosing the most appropriate and personalised treatment.

Keywords: Markers; Multiparametric magnetic resonance imaging; Prostate cancer; Prostate-specific antigen; Staging.

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Figures

Figure 1
Figure 1
The TRUS non-targeted technique carries a risk of sampling error. (A) Missed anterior and posterior cancer; (B) Under evaluation of TRUS for aggressive cancer indicated in red colour; (C) Over detection of indolent cancer. TRUS, transrectal ultrasound.
Figure 2
Figure 2
mpMRI demonstrate anterior T3 cancer, Gleason 4 + 3 on biopsy core, with suspected capsular extension to seminal vesicle. (A) Large hypointense signal on T2 axial-weighted imaging; (B) Tumor enhancement on DCE-Imaging; (C) Diffusion-weighted imaging; (D) Apparent diffusion coefficient map (used as predictor of tumor aggressiveness). mpMRI, multiparametricmagnetic resonance imaging; DCE, dynamic contrasted-enhanced.
Figure 3
Figure 3
Suspected Lymph Node on 18F-choline positon emission tomography (confirmed during lymphadenectomy).
See this image and copyright information in PMC

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