IMAGING PROSTATE CANCER - 06/09/11
Résumé |
The clinical management of prostate cancer continues to be one of the most controversial areas in medicine, with no consensus on the need for cancer screening, choice of diagnostic tests for pretreatment evaluation, and the need for and appropriateness of treatment for any stage of disease.66 Controversies in management can be attributed to several unique biologic features of the disease.77 For example, many prostate cancers do not lead to serious morbidity or death. Autopsy studies have shown that 30% to 46% of men older than age 50 have microscopic prostate cancer, yet less than 20% of men develop clinical prostate cancer in their lifetime.36, 66 Unlike other cancers (e.g., lung, colon, breast, or ovarian cancer), which behave aggressively and are more rapidly and uniformly fatal if untreated, prostate cancer behaves in a less predictable manner. Some cancers are small, well differentiated, and unlikely to cause clinically significant disease, whereas others are large, poorly differentiated, and likely to metastasize, causing death. Despite recent advances in the diagnosis, pretreatment evaluation, and treatment of prostate cancer, significant gaps in knowledge of the underlying pathophysiology of this disease remain.
Several major obstacles impede the optimal clinical management of prostate cancer. The first obstacle, related to early detection, is the inability of screening tests to differentiate subclinical disease from clinically significant prostate cancer. Although there is evidence suggesting that most (85% to 90%) cancers detected through prostate cancer screening programs represent clinically significant rather than insignificant disease and are detected at an earlier stage of disease, the feasibility of prostate cancer screening in the general population remains controversial, and the costs of undertaking screening in all men over age 50 years far exceeds presently available health care funds.40, 54, 77, 85 The second obstacle is related to treatment planning. There are limitations of currently available tumor prognostic factors in differentiating indolent from aggressive disease. Although a number of tumor prognostic factors (e.g., tumor volume, grade, and stage) can generally predict disease at either end of the spectrum, most cancers fall into an intermediate range, where it is difficult to distinguish those cancers likely to progress from those that can be observed.55, 79 There continues to be intense debate about the ability of currently available tumor prognostic factors accurately to assign patients to appropriate risk and treatment categories.77
Prostate cancer is usually suspected due to an abnormal digital rectal examination (DRE) or elevated serum prostate-specific antigen (PSA) level (Figure 1). American Cancer Society recommendations for the annual cancer prevention check-up includes DRE and serum PSA testing for men older than 50 years or for younger men at increased risk (black race or family history of prostate cancer) for the disease.47 Imaging provides additional information in patients with a histologic diagnosis of prostate cancer, but imaging findings alone are not sufficient for the primary diagnosis of prostate cancer. The diagnosis of prostate cancer depends on the histopathologic evaluation of tissue specimens obtained from digitally or transrectal ultrasound (TRUS)–guided prostate biopsies (see Figure 1).39 Systematic (sextant) core biopsies of the prostate are recommended to maximize the diagnostic yield of biopsy and to allow estimation of tumor grade and volume.60
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| Address reprint requests to Hedvig Hricak, MD, PhD, Department of Radiology, Box 29, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021 This work was supported by a GE-AUR Radiology Research Academic Fellowship. |
Vol 38 - N° 1
P. 59-85 - janvier 2000 Retour au numéro
Article précédent
- PROSTATE CANCER: ASSESSMENT OF RISK USING DIGITAL RECTAL EXAMINATION, TUMOR GRADE, PROSTATE-SPECIFIC ANTIGEN, AND SYSTEMATIC BIOPSY
- Joseph C. Presti
- PROSTATE CANCER: THE ROLE OF TRANSRECTAL ULTRASOUND AND ITS IMPACT ON CANCER DETECTION AND MANAGEMENT
- Peter J. Littrup, Sharlene E. Bailey
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