Advances in the Assessment of Clinically Localized Prostate Cancer

Comparison of Digital Rectal Examination, Transrectal Ultrasonography, and Multicoil Magnetic Resonance Imaging for Preoperative Evaluation of Prostate Cancer

“…Early detection and proper preoperative evalua tion of prostate cancers are at present topics of major con cern. The findings of DRE, TRUS, and serum PSA and especially the pathologic conclusions derived from system atic biopsy of prostate and seminal vesicles are currently available tools for preoperative estimation of tumor vol ume and local extent of prostate cancer [5]. MRI using integrated endorectal and PPA coils is a new diagnostic modality, the potentials of which for preoperative staging in prostate cancer are at present under investigation.…”

“…However, stag ing results were dissapointing as neither TRUS nor pelvic MRI can reliably differentiate local from advanced dis ease in patients presenting with clinically localized pros tate cancer [7,17]. Tumor detection in the anterior gland is difficult, and hemorrhages or edemas related to biopsy may mimic tumor, capsular penetration, and seminal ves icle invasion on MRI [5], In this sense, some authors sug gest waiting several weeks after biopsy before performing MRI examination [30].…”

“…The number of positive sextant biopsies correlates with traditional prognostic indicators [5,23], but may not be accurate to determine itself the tumor stage or predict the seminal vesicle invasion in the individual patient [20,21,24], Ultrasound-guided biopsy may allow identifica tion of cancer in the periprostatic fat or seminal vesicles [25,26], thus preoperatively revealing extraprostatic dis ease. Other biopsy features that include percentage of tumor in the specimen and total length of cancer, in addi tion to Gleason score and serum PSA, appear undoubted ly helpful in the identification of patients with cancer at an early stage of disease and, therefore, amenable to radi cal surgery [5,21,24].…”

“…Other biopsy features that include percentage of tumor in the specimen and total length of cancer, in addi tion to Gleason score and serum PSA, appear undoubted ly helpful in the identification of patients with cancer at an early stage of disease and, therefore, amenable to radi cal surgery [5,21,24]. Besides, newer predictors in needle biopsy specimes (e.g., optimized microvessel density anal ysis) could also assist in treatment decisions [27], On the other hand, while efforts are made to obtain as much information as possible from needle biopsy speci mens, newer imaging modalities are being developed, and their ability to preoperatively stage prostate cancer is being tested.…”

Imaging with radiolabelled monoclonal antibody (MUJ591) to prostate‐specific membrane antigen in staging of clinically localized prostatic carcinoma: comparison with clinical, surgical and histological staging

“…Prostate cancer is the most commonly diagnosed cancer among men in the western world, accounting for 30% of all new cases of cancer and 14% of deaths from cancer [1]. Staging investigations focus on the involvement of the prostatic capsule, and pelvic lymph node and skeletal metastasis [2]. Local staging is particularly valuable in patients considered for radical prostatectomy, as extracapsular extension and positive surgical margins indicate an adverse prognosis in these patients [3,4].…”