Rak gruczołu krokowego z przerzutami – Diagnostyka i diagnoza

Rak gruczołu krokowego z przerzutami
Diagnostyka i diagnoza

Rak gruczołu krokowego z przerzutami stanowi zaawansowane stadium IV choroby, charakteryzujące się rozprzestrzenieniem komórek nowotworowych poza prostatę do odległych narządów, najczęściej kości (ponad 60% przypadków), węzłów chłonnych, płuc, wątroby oraz mózgu. Diagnostyka opiera się na ocenie stężenia PSA, gdzie wartości powyżej 10 ng/mL, wysoki stopień Gleasona (≥7) oraz objawy kliniczne sugerujące stadium T3 lub wyższe wskazują na konieczność dalszych badań obrazowych. Biopsja prostaty, szczególnie kierowana TRUS, pozostaje złotym standardem potwierdzającym rozpoznanie i oceniającym agresywność nowotworu. W diagnostyce przerzutów stosuje się scyntygrafię kości, tomografię komputerową (CT), rezonans magnetyczny (MRI) oraz nowoczesne techniki obrazowania, takie jak PET-CT z użyciem radioznacznika Ga-68 PSMA, który wykazuje wyższą czułość i specyficzność w wykrywaniu przerzutów w porównaniu do tradycyjnych metod (dokładność 92% vs 65%). Kompleksowa ocena stopnia zaawansowania opiera się na systemie TNM, poziomie PSA oraz skali Gleasona, co umożliwia precyzyjne planowanie terapii.

Diagnostyka raka gruczołu krokowego z przerzutami

Rak gruczołu krokowego z przerzutami (metastatic prostate cancer) to zaawansowana postać nowotworu, która rozprzestrzeniła się poza prostatę do innych części ciała. Jest to stadium IV raka prostaty, gdzie komórki nowotworowe przemieściły się do odległych narządów lub tkanek. Dokładna i wczesna diagnostyka ma kluczowe znaczenie dla ustalenia optymalnego planu leczenia i poprawy rokowania pacjenta.¹²

Najczęstsze miejsca przerzutów

Rak gruczołu krokowego najczęściej daje przerzuty do następujących miejsc:³

Kości (ponad 60% pacjentów z zaawansowanym rakiem prostaty rozwinie przerzuty do kości)
Węzły chłonne (lokalne i odległe)
Płuca
Wątroba
Mózg

⁴⁵

Podstawowe badania diagnostyczne

Diagnostyka raka gruczołu krokowego z przerzutami obejmuje szereg badań, które pozwalają na dokładne określenie stopnia zaawansowania choroby i zaplanowanie odpowiedniego leczenia.⁶

Badanie PSA (Prostate-Specific Antigen)

Badanie stężenia antygenu PSA to podstawowy test we wstępnej diagnostyce raka prostaty oraz w monitorowaniu pacjentów po wcześniejszym leczeniu. Wysokie poziomy PSA mogą wskazywać na obecność raka gruczołu krokowego, jednak sam test nie jest wystarczający do postawienia ostatecznej diagnozy.⁷⁸

PSA pozostaje kluczowym markerem biologicznym w diagnostyce raka prostaty, jak wskazano w przeglądach naukowych. Istnieje wyraźny związek między wysokimi wartościami PSA a zwiększonym ryzykiem raka prostaty. Wybór wartości progowej PSA, przy której zaleca się wykonanie biopsji, pozostaje kwestią dyskusyjną.⁹

Poziom PSA powyżej 10 ng/mL, wysoki stopień w skali Gleason (7 lub wyższy) lub zmiany w badaniu fizykalnym sugerujące stadium T3 choroby są wskazaniami do wykonania badań obrazowych w celu oceny stadium zaawansowania.¹⁰

Pacjenci z przerzutowym rakiem prostaty zazwyczaj mają wyższe poziomy PSA. Jednakże w rzadkich przypadkach możliwe jest występowanie niskiego poziomu PSA pomimo obecności choroby przerzutowej. Dla tych pacjentów postęp choroby lepiej mierzyć w inny sposób, np. poprzez badania obrazowe i narzędzia biomarkerowe.¹¹

Badanie per rectum (DRE)

Badanie per rectum to podstawowe badanie fizykalne, które może sugerować obecność raka prostaty. Jeśli wynik badania DRE jest nieprawidłowy, wskazane jest wykonanie biopsji prostaty, niezależnie od poziomu PSA.¹²

Biopsja prostaty

Biopsja prostaty jest niezbędna do potwierdzenia diagnozy raka gruczołu krokowego. Polega na pobraniu małych próbek tkanki prostaty, które następnie są badane pod mikroskopem w celu wykrycia komórek nowotworowych.¹³

Biopsja gruczołu krokowego pozostaje złotym standardem badania potwierdzającego diagnozę we wszystkich sytuacjach klinicznych. Biopsja kierowana TRUS (przezodbytniczo pod kontrolą USG) jest standardowym testem diagnostycznym dla raka prostaty od czasu przełomowego badania z 1989 roku, które wykazało, że jest ona lepsza niż biopsja kierowana cyfrowo.¹⁴

Wyniki biopsji prostaty są wykorzystywane do oceny stopnia zaawansowania i agresywności nowotworu, co ma kluczowe znaczenie dla określenia planu leczenia.¹⁵

Badania obrazowe w diagnostyce przerzutów

Badania obrazowe odgrywają kluczową rolę w diagnostyce przerzutów raka gruczołu krokowego. Pozwalają one określić, czy nowotwór rozprzestrzenił się poza prostatę, a jeśli tak, to do jakich narządów.¹⁶

Scyntygrafia kości

Scyntygrafia kości jest wykorzystywana do wykrywania przerzutów raka prostaty do kości, które są najczęstszym miejscem przerzutów tego nowotworu. Badanie polega na podaniu dożylnym niewielkiej dawki substancji radioaktywnej (radioznacznika), która gromadzi się w obszarach o zwiększonej aktywności metabolicznej kości, co może wskazywać na obecność przerzutów.¹⁷¹⁸

Wytyczne NCCN sugerują, że scyntygrafia kości powinna być wykonywana u mężczyzn, którzy spełniają którekolwiek z następujących kryteriów:

Choroba w stadium klinicznym T1 i PSA ≥20 ng/mL
Choroba w stadium klinicznym T2 i PSA ≥10 ng/mL
Wynik w skali Gleasona ≥8
Choroba w stadium klinicznym T3 lub T4
Objawy sugerujące przerzuty

¹⁹

Tomografia komputerowa (CT)

Tomografia komputerowa (CT) pozwala wykryć, czy rak rozprzestrzenił się poza prostatę, na przykład do węzłów chłonnych lub pobliskich kości. Badanie to wykorzystuje promieniowanie rentgenowskie do stworzenia szczegółowych obrazów przekrojowych ciała.²⁰²¹

CT jest szczególnie przydatne do wykrywania raka prostaty, który rozprzestrzenił się do wątroby, jelit lub kości jamy brzusznej i miednicy. Rak, który rozprzestrzenił się do węzłów chłonnych, również może być wykryty, jeśli węzły chłonne uległy powiększeniu.²²

Rezonans magnetyczny (MRI)

Rezonans magnetyczny (MRI) może wykryć raka, który rozprzestrzenił się do węzłów chłonnych lub innych miejsc w ciele. MRI wykorzystuje silne pole magnetyczne i fale radiowe do tworzenia szczegółowych obrazów tkanek miękkich, co czyni go szczególnie przydatnym w obrazowaniu prostaty i okolicznych tkanek.²³

Wieloparametryczny rezonans magnetyczny (mpMRI) jest nowoczesną metodą diagnostyczną, która może być stosowana do:

Wykrywania raka w przedniej części prostaty, który może zostać pominięty w innych badaniach
Poszukiwania raka prostaty, gdy lekarz podejrzewa jego obecność, ale nie został on wykryty biopsją
Pomiaru wielkości prostaty lub guza w prostacie
Pomocy w planowaniu radioterapii w leczeniu raka prostaty
Kierowania igłą podczas biopsji prostaty

²⁴

Badania PET/PET-CT

Pozytonowa tomografia emisyjna (PET) może badać całe ciało w celu wykrycia przerzutowego raka prostaty. Jest to technika obrazowania, która wykorzystuje radioznaczniki do uwidocznienia aktywnych metabolicznie tkanek w ciele, takich jak komórki rakowe.²⁵

PET PSMA (prostate-specific membrane antigen) jest nowoczesnym badaniem stosowanym do wykrywania raka prostaty, który rozprzestrzenił się poza prostatę. Badanie to wykorzystuje substancję, która wiąże się z białkiem PSMA, obecnym w wysokich stężeniach na powierzchni komórek raka prostaty.²⁶

Badanie PET PSMA wykazuje większą dokładność w diagnozowaniu raka prostaty, który dał przerzuty do węzłów chłonnych, innych narządów lub kości, w porównaniu z tradycyjnymi metodami diagnostycznymi.²⁷

W ostatnich latach zatwierdzono do stosowania w diagnostyce raka prostaty radioaktywny znacznik Gallium (Ga) 68 PSMA-11. Zgodnie z zatwierdzeniem, znacznik ten może być stosowany w obrazowaniu PET raka prostaty, który jest podejrzewany o rozprzestrzenienie się do innych części ciała.²⁸

Badania wykazały, że PET-CT z PSMA jest znacznie bardziej skuteczne w wykrywaniu przerzutów niż tradycyjne podejście wykorzystujące skan CT i scyntygrafię kości. PET-CT z PSMA było o 27% dokładniejsze niż standardowe podejście w wykrywaniu przerzutów (92% vs 65%). Była również bardziej dokładna zarówno w przypadku przerzutów w węzłach chłonnych w miednicy, jak i w bardziej odległych częściach ciała, w tym w kościach.²⁹

Nowoczesne metody diagnostyczne

Badania biomarkerów

Biomarkery to biologiczne cząsteczki, które mogą wskazywać na obecność raka prostaty lub pomóc w monitorowaniu odpowiedzi na leczenie. Nowoczesne testy biomarkerów umożliwiają precyzyjne wykrycie raka prostaty, ukierunkowanie decyzji dotyczących leczenia oraz ocenę ryzyka progresji choroby.³⁰

Dostępne są następujące nowoczesne testy diagnostyczne:

Test 4Kscore – badanie krwi wykonywane po nieprawidłowym wyniku testu PSA lub DRE, oceniające ryzyko agresywnego raka prostaty
Prostate Health Index (PHI) – nowa kombinacja 3 badań krwi, której wynik dostarcza informacji o prawdopodobieństwie wykrycia raka przy biopsji po podwyższonym poziomie PSA
Badanie moczu na obecność PCA3 – wykrywa gen specyficzny dla raka prostaty, obecny w ponad 90% tkanek raka prostaty, ale nie w zdrowej tkance
ConfirmMDx – test wykonywany na próbkach biopsji prostaty, które nie wykazały obecności raka, pomocny w decyzji o powtórzeniu biopsji
Testy genetyczne – wykonywane na tkankach z biopsji prostaty, takie jak Prolaris i Oncotype DX GPS, dostarczające dodatkowych informacji o agresywności nowotworu

³¹³²³³

Badania genetyczne

Badania genetyczne wykorzystują próbki krwi lub śliny do poszukiwania wariantów w DNA. Niektóre metody leczenia przerzutowego raka prostaty działają lepiej u osób, które urodziły się z określonymi wariantami DNA lub u których takie warianty się rozwinęły.³⁴

U pacjentów z przerzutowym, opornym na kastrację rakiem prostaty, badania genetyczne (germline i somatyczne) są wykorzystywane do identyfikacji mutacji, które mogą ukierunkować terapie celowane.³⁵

U pacjentów z rakiem prostaty opornym na kastrację (mCRPC) zaleca się badania genetyczne germline (jeśli nie zostały jeszcze wykonane) i somatyczne w celu identyfikacji deficytów naprawy DNA, statusu MSI, obciążenia mutacyjnego guza i innych potencjalnych mutacji, które mogą wpływać na rokowanie i ryzyko raka rodzinnego, a także ukierunkować potencjalne terapie celowane.³⁶

Staging i ocena stopnia zaawansowania

Ocena stopnia zaawansowania (staging) raka gruczołu krokowego jest kluczowym elementem w procesie diagnostycznym, ponieważ determinuje wybór odpowiedniej metody leczenia i pomaga przewidzieć rokowanie pacjenta.³⁷

System TNM

Najczęściej stosowanym systemem oceny stopnia zaawansowania raka prostaty jest system TNM (Tumor, Nodes, Metastasis) opracowany przez American Joint Committee on Cancer (AJCC), który uwzględnia:

T – zasięg guza pierwotnego
N – zajęcie węzłów chłonnych
M – obecność przerzutów odległych
Poziom PSA w momencie diagnozy
Grupa stopnia (oparta na skali Gleasona) – określa jak szybko nowotwór może rosnąć i rozprzestrzeniać się

³⁸³⁹

W klasyfikacji TNM, przerzutowy rak prostaty jest klasyfikowany jako dowolne T, dowolne N, M1, co oznacza, że nowotwór rozprzestrzenił się poza prostatę do odległych części ciała.⁴⁰

Skala Gleasona i grupy stopnia

Skala Gleasona jest systemem oceny agresywności raka prostaty na podstawie wyglądu komórek nowotworowych pod mikroskopem. Wyniki w skali Gleasona wahają się od 2 do 10, gdzie wyższy wynik wskazuje na bardziej agresywny nowotwór.⁴¹

Wynik w skali Gleasona jest podstawą do przydzielenia do odpowiedniej grupy stopnia (Grade Group), która jest ważnym czynnikiem w określaniu rokowania i planowaniu leczenia. Grupy stopnia wahają się od 1 (najmniej agresywny) do 5 (najbardziej agresywny).⁴²

Szczegółowa ocena stopnia zaawansowania raka prostaty uwzględnia różne elementy, w tym wynik w skali Gleasona, poziom PSA i wyniki badań obrazowych. Dokładna ocena stopnia zaawansowania jest kluczowa dla określenia odpowiedniego planu leczenia i przewidywania rokowania.⁴³

Różnicowa diagnostyka w przerzutowym raku prostaty

W procesie diagnostycznym raka gruczołu krokowego z przerzutami istotne jest również różnicowanie przyczyn podwyższonego poziomu PSA oraz wykluczenie innych schorzeń, które mogą dawać podobne objawy.⁴⁴

Poziom PSA może wzrosnąć z różnych przyczyn, nie tylko z powodu raka prostaty. Może być to związane z:

Zapaleniem prostaty
Łagodnym przerostem prostaty
Niedawnym urazem prostaty
Niektórymi lekami
Intensywnym wysiłkiem fizycznym

⁴⁵

Jednak bardzo wysokie poziomy PSA (powyżej 100 ng/mL) często sugerują przerzutowy rak prostaty. Gdy PSA przekracza 100 ng/mL, prawdopodobieństwo wykrycia raka prostaty wynosi co najmniej 75%. Wysokie poziomy całkowitego PSA korelują z większą objętością raka, wysokim wynikiem w skali Gleasona (7 lub wyższy) i penetracją torebki w preparatach po radykalnej prostatektomii.⁴⁶

Rokowanie i przeżycie

Rokowanie u pacjentów z rakiem gruczołu krokowego z przerzutami zależy od wielu czynników, w tym zakresu przerzutów, odpowiedzi na leczenie oraz ogólnego stanu zdrowia pacjenta.⁴⁷

Według American Cancer Society, 5-letni względny wskaźnik przeżycia dla odległego (przerzutowego) raka prostaty wynosi około 34%. Ważne jest, aby omówić indywidualne rokowanie z zespołem opieki zdrowotnej.⁴⁸

Średnia długość przeżycia po nowym rozpoznaniu przerzutowego raka prostaty wynosi około 5-6 lat. Istotne jest jednak pamiętanie, że rak prostaty to nie choroba jednorodna. Wskaźniki przeżycia są średnimi wartościami – niektórzy pacjenci będą żyć dłużej niż średnia, a niektórzy krócej. W przypadku przerzutowego raka prostaty po leczeniu hormonalnym, gdy choroba staje się oporna na kastrację, średnie przeżycie wynosi zwykle 2-3 lata.⁴⁹

Czynniki wpływające na rokowanie w przerzutowym raku prostaty obejmują:

Zakres przerzutów: liczba i lokalizacja miejsc przerzutów może wpływać na rokowanie
Odpowiedź na leczenie
Wiek pacjenta i ogólny stan zdrowia
Profil genetyczny nowotworu

⁵⁰

Diagnostyka raka gruczołu krokowego z przerzutami – zintegrowane podejście

Diagnostyka raka gruczołu krokowego z przerzutami wymaga kompleksowego, wielodyscyplinarnego podejścia. Proces diagnostyczny powinien obejmować badania krwi, badania obrazowe oraz, w razie potrzeby, biopsję w celu potwierdzenia diagnozy i określenia stopnia zaawansowania choroby.⁵¹

Wiedza o tym, czy rak rozprzestrzenił się poza prostatę, jest kluczowa dla optymalizacji leczenia u pacjentów. Nowoczesne metody diagnostyczne, takie jak badanie PET PSMA, umożliwiają wcześniejsze i dokładniejsze wykrycie przerzutów.⁵²

Dokładna diagnoza, określenie stopnia zaawansowania choroby oraz identyfikacja miejsc przerzutów są niezbędne do zaplanowania odpowiedniego leczenia i poprawy jakości życia pacjentów z rakiem gruczołu krokowego z przerzutami.⁵³⁵⁴

Wczesne wykrycie przerzutów może pozwolić na wdrożenie odpowiedniego leczenia, które, chociaż nie zapewni wyleczenia, może znacząco spowolnić postęp choroby i zmniejszyć nasilenie objawów, przyczyniając się do poprawy jakości życia pacjentów z rakiem gruczołu krokowego z przerzutami.⁵⁵⁵⁶

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Materiały źródłowe

#1 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#2 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
Metastatic prostate cancer means that the cancer has spread beyond the prostate to distant lymph nodes or organs, often to bones. […] Metastatic prostate cancer or stage IV (4) prostate cancer generally refer to cancer that has spread beyond the lymph nodes and tissues immediately surrounding the prostate. […] Prostate cancer most frequently spreads to the bones, liver, or lungs. […] Prostate cancer most commonly spreads to the bones, followed by the lymph nodes, lungs, liver, and brain. […] Prostate cancer that has metastasized to the bones is still prostate cancer, not bone cancer. […] More than 60% of men with advanced prostate cancer will eventually develop bone metastases. […] When prostate cancer spreads beyond the prostate to another organ, most frequently it spreads to the bone. Prostate cancer that spread to the bone is still considered prostate cancer. It is still treated with therapy for prostate cancer.
#3 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
Metastatic prostate cancer means that the cancer has spread beyond the prostate to distant lymph nodes or organs, often to bones. […] Metastatic prostate cancer or stage IV (4) prostate cancer generally refer to cancer that has spread beyond the lymph nodes and tissues immediately surrounding the prostate. […] Prostate cancer most frequently spreads to the bones, liver, or lungs. […] Prostate cancer most commonly spreads to the bones, followed by the lymph nodes, lungs, liver, and brain. […] Prostate cancer that has metastasized to the bones is still prostate cancer, not bone cancer. […] More than 60% of men with advanced prostate cancer will eventually develop bone metastases. […] When prostate cancer spreads beyond the prostate to another organ, most frequently it spreads to the bone. Prostate cancer that spread to the bone is still considered prostate cancer. It is still treated with therapy for prostate cancer.
#4 Prostate Cancer | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/prostate-cancer.html
Metastatic prostate cancer is prostate cancer that has spread outside of the prostate to other parts of the body. This is also known as stage IV disease. […] At MD Anderson, I treat patients with advanced prostate cancer, most of whom have metastatic disease. A lot of our research is focused on how we can better treat metastatic prostate cancer to improve patients results. […] Prostate cancer often spreads to the bones and lymph nodes. It most commonly spreads to bones in the pelvis or spine. Sometimes it spreads to the ribs. […] Weve known since the 1940s that prostate cancer is a hormone-driven disease. Early studies showed that surgically removing the testes in men, which decreases the bodys testosterone, led to improvement in prostate cancer temporarily, at least. […] Surgery is usually not an option for metastatic prostate cancer. At MD Anderson, we work together as a team of specialists to treat stage IV prostate cancer. Patients may receive:
#5 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
Metastatic prostate cancer means that the cancer has spread beyond the prostate to distant lymph nodes or organs, often to bones. […] Metastatic prostate cancer or stage IV (4) prostate cancer generally refer to cancer that has spread beyond the lymph nodes and tissues immediately surrounding the prostate. […] Prostate cancer most frequently spreads to the bones, liver, or lungs. […] Prostate cancer most commonly spreads to the bones, followed by the lymph nodes, lungs, liver, and brain. […] Prostate cancer that has metastasized to the bones is still prostate cancer, not bone cancer. […] More than 60% of men with advanced prostate cancer will eventually develop bone metastases. […] When prostate cancer spreads beyond the prostate to another organ, most frequently it spreads to the bone. Prostate cancer that spread to the bone is still considered prostate cancer. It is still treated with therapy for prostate cancer.
#6 Tests for Prostate Cancer | Prostate Cancer Diagnosis | American Cancer Society
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
Most prostate cancers are first found as a result of screening. […] If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. […] The actual diagnosis of prostate cancer can only be made with a prostate biopsy. […] The PSA blood test can be used to screen for prostate cancer in men without symptoms. […] Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer. […] If your PSA level is high, you might need further tests to look for prostate cancer. […] If the results of a PSA blood test, DRE, or other tests suggest that you might have prostate cancer, you will most likely need a prostate biopsy. […] A biopsy is a procedure in which small samples of the prostate are removed and looked at with a microscope.
#7 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#8 Tests for Prostate Cancer | Prostate Cancer Diagnosis | American Cancer Society
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
Most prostate cancers are first found as a result of screening. […] If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. […] The actual diagnosis of prostate cancer can only be made with a prostate biopsy. […] The PSA blood test can be used to screen for prostate cancer in men without symptoms. […] Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer. […] If your PSA level is high, you might need further tests to look for prostate cancer. […] If the results of a PSA blood test, DRE, or other tests suggest that you might have prostate cancer, you will most likely need a prostate biopsy. […] A biopsy is a procedure in which small samples of the prostate are removed and looked at with a microscope.
#9 Diagnosis of prostate cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC6488713/
Today, TRUS prostate biopsy remains the gold standard examination to confirm diagnosis in all these clinical situations. […] TRUS-guided systematic biopsy has been the standard diagnostic test for PCa since a landmark study in 1989 which showed that it was superior to digitally directed biopsy sampling of the prostate. […] Thus urologists need to improve the selection of patients requiring a biopsy and evaluate their technique to identify and hit potential aggressive lesions. […] Total PSA (tPSA) remains the cornerstone of biological test in this evolving landscape of tumor markers, as reported in a recent exhaustive review. High PSA value is clearly associated with an increased risk of PCa. […] The choice of a PSA threshold at which a clinician might recommend a biopsy remains controversial.
#10 Prostate Cancer Diagnosis and Staging: Practice Essentials, Overview, Relevant Anatomy
https://emedicine.medscape.com/article/458011-overview
Men with PSA levels above 10 ng/mL, high-grade histology (Gleason score of 7), or physical findings suggesting stage T3 disease should probably undergo a staging CT scan and bone scan. […] Staging of prostate cancer is based on the following five key pieces of information: The extent of the primary tumor (T category), Whether the cancer has spread to nearby lymph nodes (N category), The absence or presence of distant metastasis (M category), The PSA level at the time of diagnosis, The Grade Group, based on prostate biopsy (or surgery). […] Metastatic symptoms include weight loss and loss of appetite; bone pain, with or without pathologic fracture; and lower extremity pain and edema due to obstruction of venous and lymphatic tributaries by nodal metastasis. […] Current guidelines from the European Society for Medical Oncology (ESMO) recommend against population-based PSA screening for prostate cancer, on the grounds that it reduces prostate cancer mortality at the expense of overdiagnosis and overtreatment.
#11 Metastatic Stage 4 Prostate Cancer: Symptoms, Treatment, Prognosis
https://www.cancercenter.com/cancer-types/prostate-cancer/types/metastatic-prostate-cancer
In metastatic or stage 4 prostate cancer, cancer cells break away from the tumor in the prostate and establish new tumors in other parts of the body. An initial diagnosis of metastatic prostate cancer is very rare. […] As part of patients’ ongoing treatment, the care team regularly tests PSA levels. PSA stands for prostate-specific antigen, which may be high in men who have prostate cancer. PSA tests are used not only for the initial cancer diagnosis but also to observe the advancement of the disease over time. […] Generally, PSA levels are higher in men with metastatic prostate cancer. However, in rare cases, its possible to have a low PSA even if a patient has metastatic disease. For these patients, disease progression is better measured in other ways, such as through imaging tests and biomarker tools.
#12 Current Diagnostics for Prostate Cancer – Prostate Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK571327/
DRE can be used as an inexpensive diagnostic tool to check the prostate for cancer and to give an assessment of the prostate volume. […] An abnormal DRE is an indication for a prostate biopsy irrespective of the PSA. […] PSA is, broadly speaking, an organ-specific glycoprotein secreted by the prostatic epithelium which may be elevated in a variety of conditions, both benign and malignant. Higher levels of PSA indicate a greater likelihood of prostate cancer. […] The unreliability of PSA means instead the urologist must take into consideration additional factors to determine if the patient should proceed to biopsy, which may include PSA derivatives. […] Additional assays are now commercially available measuring a panel of kallikreins. The use of these tests aims to reduce the number of unnecessary prostate biopsies.
#13 Tests for Prostate Cancer | Prostate Cancer Diagnosis | American Cancer Society
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
Most prostate cancers are first found as a result of screening. […] If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. […] The actual diagnosis of prostate cancer can only be made with a prostate biopsy. […] The PSA blood test can be used to screen for prostate cancer in men without symptoms. […] Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer. […] If your PSA level is high, you might need further tests to look for prostate cancer. […] If the results of a PSA blood test, DRE, or other tests suggest that you might have prostate cancer, you will most likely need a prostate biopsy. […] A biopsy is a procedure in which small samples of the prostate are removed and looked at with a microscope.
#14 Diagnosis of prostate cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC6488713/
Today, TRUS prostate biopsy remains the gold standard examination to confirm diagnosis in all these clinical situations. […] TRUS-guided systematic biopsy has been the standard diagnostic test for PCa since a landmark study in 1989 which showed that it was superior to digitally directed biopsy sampling of the prostate. […] Thus urologists need to improve the selection of patients requiring a biopsy and evaluate their technique to identify and hit potential aggressive lesions. […] Total PSA (tPSA) remains the cornerstone of biological test in this evolving landscape of tumor markers, as reported in a recent exhaustive review. High PSA value is clearly associated with an increased risk of PCa. […] The choice of a PSA threshold at which a clinician might recommend a biopsy remains controversial.
#15 Diagnosis of Prostate Cancer – Prostate Cancer | UCLA Health Jonsson Comprehensive Cancer Center
https://www.uclahealth.org/cancer/cancer-services/prostate-cancer/diagnosis-prostate-cancer
Targeted biopsy is being used at UCLA’s Prostate Cancer Program to diagnose prostate cancer. […] If cancer is confirmed by the biopsy, the tumors aggressiveness can be characterized using the Gleason grading system. […] In order to help better determine potential treatment options for men diagnosed with cancer confined to the prostate, further analysis of the tissue obtained by biopsy can be performed.
#16 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#17 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#18 Advanced prostate cancer | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/prostate-cancer/advanced-prostate-cancer
A PSA test is when your doctors take a blood sample to check the PSA level (prostate-specific antigen) in your blood. […] A bone scan uses a low dose of radiation to show abnormal areas of bone. […] A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of the body. […] You may have an MRI scan before you have a biopsy. Specialised scans called multi-parametric MRI scans can give more detailed images of the body.
#19 Diagnosis of prostate cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC6488713/
PSA kinetics have emerged and may have greater specificity for clinically significant PCa. […] A recent meta-analysis demonstrated that MRI-targeted biopsy significantly increases the detection rate of clinically significant cancers and decreases the detection on indolent cancers. […] The NCCN guidelines suggest that bone scan should be performed in men who meet any of the following criteria: Clinical T1 disease and PSA 20 ng/mL, clinical T2 disease and PSA 10 ng/mL, Gleason score 8, clinical T3 or T4 disease, or symptoms suggestive of metastases.
#20 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#21 Scans to see if your cancer has spread | Prostate Cancer UK
https://prostatecanceruk.org/prostate-information-and-support/prostate-tests/scans-to-see-if-your-cancer-has-spread/
If you’re diagnosed with prostate cancer, you might need scans to find out the stage of your cancer in other words, whether it has spread outside your prostate and how far it has spread. […] The results should help you and your doctor to discuss suitable treatments. […] A CT (computerised tomography) scan can show whether the cancer has spread outside the prostate, for example to the lymph nodes or nearby bones. […] The scan results will help your doctor to work out the most suitable treatment options for you. […] A bone scan can show whether any cancer cells have spread to your bones, which is a common place for prostate cancer to spread to. […] The doctor will look at the scan images to see if there is any cancer in your bones. […] Your doctor will use your scan results to work out the stage of your cancer in other words, how far it has spread. […] The M stage shows whether the cancer has spread (metastasised) to other parts of the body.
#22 Diagnosing metastatic spread outside the prostate – Prostate Matters
https://prostatematters.co.uk/diagnosis-of-prostate-cancer/diagnosing-metastatic-spread-outside-the-prostate/
CT scans can be used to locate prostate cancer that has spread to the liver, intestines, or bones of the abdomen and pelvis. Cancer which has spread to the lymph nodes can also be detected if the lymph nodes have become enlarged. The normal size range of lymph nodes varies by anatomical region. Nodes are considered abnormal with a short axis dimeter of 8 mm in the pelvis and 10 mm outside the pelvis, however, this size threshold has poor sensitivity for detecting metastatic involvement; decreasing these thresholds improves sensitivity but reduces specificity, thus size threshold alone remains sub-optimal. […] Next generation imaging for prostate cancer is a broad term which incorporates imaging techniques to stage prostate cancer beyond conventional imaging with bone scintigraphy and CT. Techniques include whole-body (WB) MRI and Positron Emission Tomography (PET) imaging using different radiotracers. The RADAR (Radiographic Assessments for Detection of Advanced Recurrence) Group recently recommended that next generation imaging techniques should be used in select patients in whom conventional imaging is equivocal or negative for metastatic involvement, but considered at high clinical risk based on laboratory (biomarker) values, comorbidities and/or symptoms.
#23 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#24 Diagnosis of prostate cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/prostate/diagnosis
A prostate biopsy may be done if the doctor finds an abnormal area during a DRE or TRUS. It may also be done if the PSA level is higher than normal or has gone up over time. […] The samples collected during a prostate biopsy are sent to the lab. The pathology report will say if cancer cells are in the sample. A positive biopsy means that cancer cells were found. A negative biopsy means that no cancer cells were found. If you have a negative biopsy, your doctor may do a repeat biopsy because in some cases a biopsy can miss cancer. […] An MRI is used to: look for cancer in the front of the prostate that may be missed with other tests; look for prostate cancer when the doctor thinks it might be present but it isn’t found with a biopsy; measure the size of the prostate or a tumour in the prostate; help plan radiation therapy to treat prostate cancer; guide the needle during a prostate biopsy.
#25 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
A PET scan can look at the whole body to detect metastatic prostate cancer. […] A PSMA PET scan can detect prostate cancer that has spread anywhere in the body. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. […] In the lab, tests can show whether the concerning growth of cells is made up of prostate cancer cells. […] Genetic testing uses a sample of blood or saliva to look for variations in the DNA. […] Some metastatic prostate cancer treatments work better in people who are born with or who develop certain DNA variations. […] If you’re interested in knowing your prognosis, talk about it with your healthcare team. Your healthcare team can explain what is considered when thinking about your prognosis.
#26 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
A PET scan can look at the whole body to detect metastatic prostate cancer. […] A PSMA PET scan can detect prostate cancer that has spread anywhere in the body. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. […] In the lab, tests can show whether the concerning growth of cells is made up of prostate cancer cells. […] Genetic testing uses a sample of blood or saliva to look for variations in the DNA. […] Some metastatic prostate cancer treatments work better in people who are born with or who develop certain DNA variations. […] If you’re interested in knowing your prognosis, talk about it with your healthcare team. Your healthcare team can explain what is considered when thinking about your prognosis.
#27 Metastatic Prostate Cancer Diagnostic Advances
https://www.healthline.com/health/prostate-cancer/advances-in-metastatic-prostate-cancer-diagnosis
Newer tests like the prostate-specific membrane antigen (PSMA) PET scan may be more accurate than conventional alternatives for detecting metastatic prostate cancer. […] Conventional tests for metastatic prostate cancer have limited accuracy, which may contribute to underdiagnosis and under-treatment. […] Phase III, randomized studies have shown that PSMA PET-CT is superior to conventional radiology studies, such as nuclear medicine bone scan, CT, or MRI, in detecting metastatic disease, said Dr. Michael Feuerstein, Chief of Urology at New York Presbyterian-Westchester. […] The PSMA PET scan is a new test for metastatic prostate cancer. It locates the protein PSMA throughout the body, which is found in high levels on prostate cancer cells. […] Compared with more conventional tests, it appears to be more accurate at diagnosing prostate cancer that has spread to the lymph nodes, other organs, or bones. […] PSMA PET scans can help people with metastatic prostate cancer get earlier and more accurate diagnoses. This may help you avoid unnecessary surgery and begin hormone therapy earlier.
#28 PSMA PET-CT Accurately Detects Prostate Cancer Spread – NCI
https://www.cancer.gov/news-events/cancer-currents-blog/2020/prostate-cancer-psma-pet-ct-metastasis
PSMA PET-CT images of a man with prostate cancer show metastases in lymph nodes in the chest and abdomen. […] On December 1, 2020, the Food and Drug Administration (FDA) approved the radioactive tracer Gallium (Ga) 68 PSMA-11 for use in PET imaging of men with prostate cancer. Under the approval, the tracer can be used in PET imaging for prostate cancer that is suspected of having spread to other parts of the body. […] In the study, an imaging method known as PSMA PET-CT was substantially more likely to detect metastatic tumors in these men than the standard imaging approach used in many countries, which involves a CT scan and a bone scan. […] But the results, Dr. Hofman said, build on evidence from other studies and current clinical practice in countries like Australia and Germany that suggest PSMA PET-CT is more likely to detect metastases than the conventional approach.
#29 PSMA PET-CT Accurately Detects Prostate Cancer Spread – NCI
https://www.cancer.gov/news-events/cancer-currents-blog/2020/prostate-cancer-psma-pet-ct-metastasis
Knowing early after diagnosis whether the cancer has already spread is key to better optimizing the treatment for these men. […] PSMA PET-CT was 27% more accurate than the standard approach at detecting any metastases (92% versus 65%). […] PSMA PET-CT was more accurate for both metastases found in lymph nodes in the pelvis and in more distant parts of the body, including bone. […] Based on imaging findings, the initial treatment plan was changed for 15% of men who underwent conventional imaging compared with 28% of men who underwent PSMA PET-CT. […] Another key finding, Dr. Hofman noted, was that PSMA PET-CT was much less likely to produce inconclusive, or equivocal, results (7% versus 23%). […] The Australian trial adds to a growing body of research on improving the detection of metastatic tumors in men with prostate cancer.
#30 Prostate Cancer Diagnosis | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/prostate/diagnosis
An accurate diagnosis is critical for planning the best treatment approach for prostate cancer. […] Our advanced detection tests find signs of the disease and whether it has spread outside the prostate. […] The two common screening tests for prostate cancer are the prostate-specific antigen (PSA) test and the digital rectal exam (DRE). Screening with one or both tests will not give you a definite diagnosis of prostate cancer. For that, we’ll do: A comprehensive examination, A prostate biopsy, An evaluation of risk factors, such as your family history of the disease, Diagnostic imaging studies. […] A biomarker is a biological molecule found in our bodies that can tell us if something is normal or not. Biomarkers have become part of the molecular tests we use to diagnose prostate cancer. New biomarkers let us precisely find prostate cancer, guide treatment decisions, monitor response to treatment, and track the cancer’s growth.
#31 Prostate Cancer Diagnosis | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/prostate/diagnosis
These are some of the new diagnostic tests available: The 4Kscore Test is a follow-up blood test given after an abnormal PSA test or DRE. It scores your risk for having aggressive prostate cancer. The information from this test can help you avoid an unnecessary prostate biopsy. […] The Prostate Health Index (PHI) is a new combination of 3 blood tests. The PHI score gives information about the chances of finding cancer with a biopsy after an elevated PSA level. […] A urine test can find PCA3, a gene that is specific to prostate cancer. It’s found in more than 90% of prostate cancer tissue but is not in normal tissue. This test can help us decide if someone who had a negative prostate biopsy should have another prostate biopsy. […] ConfirmMDx is a test done on prostate biopsy samples that did not show cancer. It can help us decide whether to repeat a biopsy. […] Several genetic tests are used on prostate biopsy tissues, including Prolaris and Oncotype DX GPS. These tests can give you and your doctor more information by measuring how aggressive the cancer is.
#32 Current Diagnostics for Prostate Cancer – Prostate Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK571327/
DRE can be used as an inexpensive diagnostic tool to check the prostate for cancer and to give an assessment of the prostate volume. […] An abnormal DRE is an indication for a prostate biopsy irrespective of the PSA. […] PSA is, broadly speaking, an organ-specific glycoprotein secreted by the prostatic epithelium which may be elevated in a variety of conditions, both benign and malignant. Higher levels of PSA indicate a greater likelihood of prostate cancer. […] The unreliability of PSA means instead the urologist must take into consideration additional factors to determine if the patient should proceed to biopsy, which may include PSA derivatives. […] Additional assays are now commercially available measuring a panel of kallikreins. The use of these tests aims to reduce the number of unnecessary prostate biopsies.
#33 Current Diagnostics for Prostate Cancer – Prostate Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK571327/
In addition to serum tests, several urinary biomarkers for prostate cancer have been described. […] The SelectMDX test has the ability to detect clinically significant prostate cancer. Further analysis has demonstrated that the use of SelectMDX may lead to a reduction in unnecessary biopsies and overtreatment. […] The role of imaging in prostate cancer diagnostics is rapidly evolving and can be used to identify clinically significant prostate cancers and avoid unnecessary biopsies. […] Multiparametric MRI can also be used for local staging of prostate cancer. […] Once a diagnosis of prostate cancer has been reached, the patient requires clinical staging in order to direct the appropriate treatment. […] A recent multicenter randomized study also found 68Ga PSMA PET-CT in men with high-risk prostate cancer was superior to bone scan and CT, with a 92% accuracy.
#34 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
A PET scan can look at the whole body to detect metastatic prostate cancer. […] A PSMA PET scan can detect prostate cancer that has spread anywhere in the body. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. […] In the lab, tests can show whether the concerning growth of cells is made up of prostate cancer cells. […] Genetic testing uses a sample of blood or saliva to look for variations in the DNA. […] Some metastatic prostate cancer treatments work better in people who are born with or who develop certain DNA variations. […] If you’re interested in knowing your prognosis, talk about it with your healthcare team. Your healthcare team can explain what is considered when thinking about your prognosis.
#35 Metastatic and Advanced Prostate Cancer: Overview, Epidemiology of Advanced Prostate Cancer, Presentation of Advanced Prostate Cancer
https://emedicine.medscape.com/article/454114-overview
In patients with newly diagnosed metastatic prostate cancer, further considerations are whether the patient is experiencing symptoms from metastatic disease, and whether the metastatic disease is low volume or high volume. High-volume disease is defined as four or more bone metastases with at least one metastasis outside of the spine/pelvis, and/or the presence of visceral metastases. […] In patients with metastatic prostate cancer, radiation is also applied for palliative purposes. It is used in patients with hormone-refractory disease with painful bone metastases and in patients with impending spinal cord compression. […] The standard treatment consists of 2 months of ADT before and then EBRT throughout. […] In patients with metastatic castration-resistant prostate cancer, germline and somatic genetic testing is used to identify mutations that may direct targeted therapies. […] The decision algorithm for initiation of treatment for biochemical failure is controversial. […] In patients with hormone-refractory prostate cancer, therapeutic options are limited, with lack of evidence for long-term survival.
#36 Advanced Prostate Cancer: AUA/SUO Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/advanced-prostate-cancer
10. In mCRPC patients without PSA progression or new symptoms, clinicians should perform imaging at least annually. (Expert Opinion) […] […] 11. In mCRPC patients with disease progression (PSA or radiographic progression or new disease-related symptoms) having previously received docetaxel and androgen pathway inhibitor, who are considering 177Lu-PSMA-617, clinicians should order PSMA PET imaging. (Expert Opinion) […] […] 12. In patients with mCRPC, clinicians should offer germline (if not already performed) and somatic genetic testing to identify DNA repair deficiency, MSI status, tumor mutational burden, and other potential mutations that may inform prognosis and familial cancer risk as well as direct potential targeted therapies. (Clinical Principle) […] […] 13. In newly diagnosed mCRPC patients, who have not received prior androgen receptor pathway inhibitors, clinicians should offer continued ADT with abiraterone acetate plus prednisone, docetaxel, or enzalutamide. (Strong Recommendation; Evidence Level: Grade A [abiraterone acetate plus prednisone and enzalutamide]/Grade B [docetaxel]) […]
#37 Prostate Cancer Stages | Staging of Prostate Cancer | American Cancer Society
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html
The stage of a prostate cancer describes how much cancer is in the body. Its one of the factors used to help determine how best to treat the cancer. Doctors also use a cancers stage when talking about survival statistics. […] The stage is based on tests described in Tests to Diagnose and Stage Prostate Cancer, including the blood PSA level and prostate biopsy results, as well as imaging tests if they are done. […] The most widely used staging system for prostate cancer is the AJCC (American Joint Committee on Cancer) TNM system, which was most recently updated in 2018. […] The TNM system for prostate cancer is based on 5 key pieces of information: The extent of the main (primary) tumor (T category), Whether the cancer has spread to nearby lymph nodes (N category), Whether the cancer has spread (metastasized) to other parts of the body (M category), The PSA level at the time of diagnosis, The Grade Group (based on the Gleason score), which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy (or surgery).
#38 Prostate Cancer Stages | Staging of Prostate Cancer | American Cancer Society
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html
The stage of a prostate cancer describes how much cancer is in the body. Its one of the factors used to help determine how best to treat the cancer. Doctors also use a cancers stage when talking about survival statistics. […] The stage is based on tests described in Tests to Diagnose and Stage Prostate Cancer, including the blood PSA level and prostate biopsy results, as well as imaging tests if they are done. […] The most widely used staging system for prostate cancer is the AJCC (American Joint Committee on Cancer) TNM system, which was most recently updated in 2018. […] The TNM system for prostate cancer is based on 5 key pieces of information: The extent of the main (primary) tumor (T category), Whether the cancer has spread to nearby lymph nodes (N category), Whether the cancer has spread (metastasized) to other parts of the body (M category), The PSA level at the time of diagnosis, The Grade Group (based on the Gleason score), which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy (or surgery).
#39 Prostate Cancer Diagnosis and Staging: Practice Essentials, Overview, Relevant Anatomy
https://emedicine.medscape.com/article/458011-overview
Men with PSA levels above 10 ng/mL, high-grade histology (Gleason score of 7), or physical findings suggesting stage T3 disease should probably undergo a staging CT scan and bone scan. […] Staging of prostate cancer is based on the following five key pieces of information: The extent of the primary tumor (T category), Whether the cancer has spread to nearby lymph nodes (N category), The absence or presence of distant metastasis (M category), The PSA level at the time of diagnosis, The Grade Group, based on prostate biopsy (or surgery). […] Metastatic symptoms include weight loss and loss of appetite; bone pain, with or without pathologic fracture; and lower extremity pain and edema due to obstruction of venous and lymphatic tributaries by nodal metastasis. […] Current guidelines from the European Society for Medical Oncology (ESMO) recommend against population-based PSA screening for prostate cancer, on the grounds that it reduces prostate cancer mortality at the expense of overdiagnosis and overtreatment.
#40 What is metastatic prostate cancer? | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/prostate-cancer/metastatic-cancer/what-is-metastatic-prostate-cancer
Metastatic prostate cancer means the cancer has spread from the prostate to other parts of the body. […] Your doctor will arrange some scans and tests if you have symptoms that could be due to metastatic prostate cancer. […] You might have tests to help diagnose metastatic prostate cancer. […] In the TNM staging system, metastatic prostate cancer is any T, any N, M1. […] Common treatments for metastatic prostate cancer include chemotherapy and hormone therapy. […] The symptoms of metastatic or advanced prostate cancer depend on where the cancer has spread to. It might include bone pain and tiredness.
#41 Metastatic Prostate Cancer Diagnosis & Treatment Information
https://xpertpatient.com/diagnosis/prostate-cancer-metastatic/
A Prostate Cancer diagnosis is based upon the results of staging and two tests called the Gleason Score and the Prostate-Specific Antigen (PSA) tests. […] Samples of your cancer cells are examined to find out your Gleason Score. A Gleason Score, which will range between 2 and 10, describes how aggressive a prostate tumor is by looking at how similar or different the cancer cells look to healthy cells. […] The recurrence rate for metastatic prostate cancer varies based on several factors, including the specific characteristics of the cancer and the treatment received. Generally, metastatic prostate cancer is associated with a high risk of recurrence because the cancer has already spread beyond the prostate gland. […] Signs and symptoms of metastatic prostate cancer may include: Painful urination, Decreased force in the stream of urine, Blood in the semen, Bone pain, Swelling in the legs, Fatigue.
#42 Prostate Cancer | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/prostate-cancer.html
The simplest screening test for prostate cancer is the digital rectal exam (DRE). […] Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. […] A blood test measures the amount of PSA circulating in the blood. This level is used to assess prostate cancer risk. […] Imaging tests may include: […] In a biopsy, a small amount of suspected cancer tissue is removed and examined under a microscope. This is the only way to tell for sure if you have prostate cancer. […] If a biopsy finds prostate cancer, it will be classified using the Gleason grading system. This helps doctors choose the best treatment options and predict how quickly the cancer is growing. […] If the prostate cancer is determined to be intermediate or high risk, imaging tests such as bone scans and CAT (computed axial tomography) or MRI (magnetic resonance imaging) scans may be used to determine if the cancer has spread.
#43 Prostate Cancer Stages | Staging of Prostate Cancer | American Cancer Society
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html
Once the T, N, and M categories have been determined, this information is combined (along with the Grade Group and PSA level if they are available) in a process called stage grouping to get the overall stage of the cancer. […] Prostate cancer staging can be complex. If you have any questions about your stage, ask someone on your cancer care team to explain it to you in a way you understand. […] While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be (and which treatments might be best), doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options. […] Newer types of lab tests can also be used to help determine if the cancer needs to be treated right away, as well as which types of treatment might be good options.
#44 Successful Diagnosis and Treatment of Occult Prostate Cancer Despite Multiple Negative Prostate Biopsies and Negative Prostate MRIs
https://www.cancernetwork.com/view/journal-successful-diagnosis-and-treatment-of-occult-prostate-cancer-despite-multiple-negative-prostate-biopsies-and-negative-prostate-mris
Prostate-specific antigen (PSA) values above 100 ng/mL often suggest metastatic prostate cancer. […] PSA values above 100 ng/ml do often suggest metastatic prostate cancer. […] Even if the disease is localized at the time of treatment, BCR is significantly higher for patients with PSA above 100 ng/mL who have undergone RP. […] A: I do not recall seeing a prior patient with such a prolonged work-up and a PSA this elevated who did not have prostate cancer. When the PSA is above 100 ng/mL, the chance of finding prostate cancer is at least 75%. […] High levels of total PSA have been shown to correlate with a larger volume of cancer, a high Gleason score (7 or higher), and capsular penetration in RP specimens. […] This case demonstrates that the accurate prediction of tumor burden and stage in a single individual can still prove to be tricky. […] Ultimately, our case highlights that there may be no PSA for which one can assume metastatic disease with certainty and that using tumor location could help stratify patient risk.
#45 Prostate Cancer: Symptoms, Stages, Diagnosis, Treatment, and More
https://www.everydayhealth.com/prostate-cancer/guide/
Prostate cancer is the fourth most commonly diagnosed cancer in the world and the second most common cancer (after skin cancer) in men, according to the American Cancer Society. […] Prostate cancer is treatable and survivable, depending on the stage at which a person is diagnosed, as well as the persons age and general health and the effectiveness of treatment. […] Your doctor may perform a number of tests to diagnose prostate cancer or to determine how advanced the cancer is, including: […] PSA levels can spike due to reasons other than prostate cancer, including inflammation, infection, certain medications, or even heavy exercise. […] According to the American Cancer Society, a PSA level between 4 and 10 is associated with a 1 in 4 chance of having prostate cancer, and a PSA level greater than 10 is associated with a more than 50 percent chance of having prostate cancer.
#46 Successful Diagnosis and Treatment of Occult Prostate Cancer Despite Multiple Negative Prostate Biopsies and Negative Prostate MRIs
https://www.cancernetwork.com/view/journal-successful-diagnosis-and-treatment-of-occult-prostate-cancer-despite-multiple-negative-prostate-biopsies-and-negative-prostate-mris
Prostate-specific antigen (PSA) values above 100 ng/mL often suggest metastatic prostate cancer. […] PSA values above 100 ng/ml do often suggest metastatic prostate cancer. […] Even if the disease is localized at the time of treatment, BCR is significantly higher for patients with PSA above 100 ng/mL who have undergone RP. […] A: I do not recall seeing a prior patient with such a prolonged work-up and a PSA this elevated who did not have prostate cancer. When the PSA is above 100 ng/mL, the chance of finding prostate cancer is at least 75%. […] High levels of total PSA have been shown to correlate with a larger volume of cancer, a high Gleason score (7 or higher), and capsular penetration in RP specimens. […] This case demonstrates that the accurate prediction of tumor burden and stage in a single individual can still prove to be tricky. […] Ultimately, our case highlights that there may be no PSA for which one can assume metastatic disease with certainty and that using tumor location could help stratify patient risk.
#47 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
While there is no cure for metastatic prostate cancer, there is hope to manage the disease effectively. […] Treatment of prostate cancer with hormone therapy, including androgen deprivation therapy (ADT), blocks the production of testosterone which stops or slows the growth of the cancer. […] It is especially important for patients taking hormone therapy to speak with their doctor about how to plan for and manage the bone loss before a problem arises. […] When making a metastatic prostate cancer treatment plan, it is important to include strategies to maintain good bone health. […] Some of the top priorities are to reduce pain, avoid loss of density, and strengthen the bones so they don’t fracture. […] Factors that impact metastatic prostate cancer prognosis include: Extent of metastasis: The number and location of metastatic sites can affect prognosis.
#48 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
Survival rates for metastatic prostate cancer can vary widely depending on individual factors. […] According to the American Cancer Society, the 5-year relative survival rate for distant (metastatic) prostate cancer is about 34%. […] It’s essential to discuss your individual prognosis with your healthcare team. […] Advances in therapies like hormone therapy, chemotherapy, immunotherapy, and targeted agents continue to improve outcomes and quality of life for men with advanced prostate cancer.
#49 Prostate Cancer | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/prostate-cancer.html
The average length of survival after a new, metastatic prostate cancer diagnosis is about 5 to 6 years. But its important to remember that prostate cancer is not a one-size-fits-all disease. Survival rates are averages. Some patients will live longer than the average, and some will live less than the average. Speak with your doctor about your specific prognosis. […] Metastatic prostate cancer goes through two phases, and this impacts the length of survival. […] During this phase, treatments directed toward the testosterone hormones are working well to keep the cancer from growing. […] Prostate cancer is smart, and eventually, it learns how to grow without testosterone. This is what we call hormone-refractory, or castration-resistant, prostate cancer. On average, metastatic prostate cancer takes 2 to 3 years to become castration-resistant, but it could be longer or shorter depending on the features of the cancer. Once the disease reaches this phase, average survival is another 2 to 3 years.
#50 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
While there is no cure for metastatic prostate cancer, there is hope to manage the disease effectively. […] Treatment of prostate cancer with hormone therapy, including androgen deprivation therapy (ADT), blocks the production of testosterone which stops or slows the growth of the cancer. […] It is especially important for patients taking hormone therapy to speak with their doctor about how to plan for and manage the bone loss before a problem arises. […] When making a metastatic prostate cancer treatment plan, it is important to include strategies to maintain good bone health. […] Some of the top priorities are to reduce pain, avoid loss of density, and strengthen the bones so they don’t fracture. […] Factors that impact metastatic prostate cancer prognosis include: Extent of metastasis: The number and location of metastatic sites can affect prognosis.
#51 Advanced prostate cancer | Prostate Cancer UK
https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/advanced-prostate-cancer/
Advanced prostate cancer is diagnosed using the results of some or all of the following tests: prostate specific antigen (PSA) test, digital rectal examination (DRE), magnetic resonance imaging (MRI) scan, computerised tomography (CT) scan, bone scan, biopsy, positron emission tomography (PET) scan. […] Your results will give your doctor an idea of where your cancer has spread to. This will help you and your doctor to discuss which treatments might be suitable for you. […] If you have advanced prostate cancer, treatment won’t cure your cancer. But it can help keep it under control and manage any symptoms. […] Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them.
#52 PSMA PET-CT Accurately Detects Prostate Cancer Spread – NCI
https://www.cancer.gov/news-events/cancer-currents-blog/2020/prostate-cancer-psma-pet-ct-metastasis
Knowing early after diagnosis whether the cancer has already spread is key to better optimizing the treatment for these men. […] PSMA PET-CT was 27% more accurate than the standard approach at detecting any metastases (92% versus 65%). […] PSMA PET-CT was more accurate for both metastases found in lymph nodes in the pelvis and in more distant parts of the body, including bone. […] Based on imaging findings, the initial treatment plan was changed for 15% of men who underwent conventional imaging compared with 28% of men who underwent PSMA PET-CT. […] Another key finding, Dr. Hofman noted, was that PSMA PET-CT was much less likely to produce inconclusive, or equivocal, results (7% versus 23%). […] The Australian trial adds to a growing body of research on improving the detection of metastatic tumors in men with prostate cancer.
#53 Metastatic prostate cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/metastatic-prostate-cancer/diagnosis-treatment/drc-20377972
Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer. […] A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer. […] If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer. […] Imaging tests used to detect metastatic prostate cancer include: A bone scan may be used to detect prostate cancer that spreads to the bones. […] A computerized tomography scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body. […] MRI can detect cancer that has spread to the lymph nodes or other places in the body.
#54 Advanced prostate cancer | Prostate Cancer UK
https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/advanced-prostate-cancer/
Advanced prostate cancer is diagnosed using the results of some or all of the following tests: prostate specific antigen (PSA) test, digital rectal examination (DRE), magnetic resonance imaging (MRI) scan, computerised tomography (CT) scan, bone scan, biopsy, positron emission tomography (PET) scan. […] Your results will give your doctor an idea of where your cancer has spread to. This will help you and your doctor to discuss which treatments might be suitable for you. […] If you have advanced prostate cancer, treatment won’t cure your cancer. But it can help keep it under control and manage any symptoms. […] Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them.
#55 Metastatic Prostate Cancer: Treatment Options & Prognosis | ZERO Prostate Cancer
https://zerocancer.org/stages-and-grades/metastatic-prostate-cancer
While there is no cure for metastatic prostate cancer, there is hope to manage the disease effectively. […] Treatment of prostate cancer with hormone therapy, including androgen deprivation therapy (ADT), blocks the production of testosterone which stops or slows the growth of the cancer. […] It is especially important for patients taking hormone therapy to speak with their doctor about how to plan for and manage the bone loss before a problem arises. […] When making a metastatic prostate cancer treatment plan, it is important to include strategies to maintain good bone health. […] Some of the top priorities are to reduce pain, avoid loss of density, and strengthen the bones so they don’t fracture. […] Factors that impact metastatic prostate cancer prognosis include: Extent of metastasis: The number and location of metastatic sites can affect prognosis.
#56 What Is Metastatic Prostate Cancer?
https://www.webmd.com/prostate-cancer/metastatic-prostate-cancer
If you have metastatic prostate cancer, your doctor will come up with the best treatment plan to manage your symptoms and slow the progression of your illness. […] Metastatic prostate cancer is an advanced form of cancer. There’s no cure, but you take steps to treat and control it. Most people with advanced prostate cancer live a normal life for many years. […] When you are diagnosed with prostate cancer, your doctor will order tests such as: X-rays, CT scans, MRI scans, PET scans. […] These tests may focus on your skeleton as well as your belly and pelvic areas. That way doctors can check for signs that the cancer has spread. […] If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spreading to your bones.