Prostate Cancer (cont.)
Prostate Cancer Workup
If cancer is present on biopsy, workup for metastasis may be indicated. Imaging studies may reveal the size and location of the tumor in the prostate as well as the extent of spread of the disease.
- Chest X-ray film: To detect whether or not cancer has spread to the lungs.
- Technetium Tc 99m bone scan: This test provides an image of the entire skeleton after a mildly radioactive substance is administered into a vein. The radioactive substance highlights areas where the cancer has affected the bones. This test is usually reserved for men with prostate cancer who have deep bone pain or a fracture or who have biopsy findings and high PSA values (>10 to 20 ng/mL) suggestive of advanced (metastatic) or aggressive disease.
- CT scan or MRI of abdomen and pelvis: This is the best way to detect the extent of the primary cancer as well as distant metastases. Pelvic CT or MRI may be considered to assess lymph node metastasis or when PSA >20 ng/mL, Clinical stage T3 to T4, or Gleason score ≥8.
- Endorectal coil MRI: The use of an endorectal probe with MRI can improve spatial resolution and thus better assess the likelihood of seminal vesicle involvement or extraprostatic extension in men who are thought to have localized prostate cancer.
- Transrectal ultrasonography (TRUS): TRUS can be used to assess the local extension of prostate cancer. Three-dimensional TRUS provides more information about the location and extent of prostate cancer with the prostate gland compared to two-dimensional imaging. However TRUS is not an accurate method for localizing early prostate cancer and is not recommended for use in prostate cancer screening. The primary role of TRUS in prostate cancer detection and diagnosis is to ensure accurate sampling of prostate tissue by prostate biopsies.
- Ultrasound of kidneys, bladder, and prostate: Ultrasonography can be used to look for the effects of a urinary blockage on the kidneys. This is indicated by signs of swelling within the kidney (hydronephrosis) or swelling of the ureters (hydroureteres). This study can also be used to assess the bladder for any sign of urinary obstruction due to prostate enlargement by looking at the thickness of the bladder wall and the amount of urine left inside the bladder after passing urine.
- Cystoscopy: This is a test that uses a thin, flexible, lighted tube with a tiny camera on the end that is inserted through the urethra to the bladder. The camera transmits images to a video monitor. This may show whether or not the cancer has spread to the urethra or bladder. This exam doesn't always require general anesthesia.
Pierre-Alain Hueber, MD, PhD
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