Prostate cancer (summary)

This is a basic article for medical students and other non-radiologists

Prostate cancer, also called carcinoma of the prostate or prostate carcinoma, is the commonest malignant tumor in men. It is primarily a disease of old age and many men remain asymptomatic. 

Reference article

This is a summary article; read more in our article on prostate cancer.

Summary

• epidemiology
  • primarily disease of elderly men
• presentation
  • elevated PSA without clinical symptoms
  • large prostate on rectal examination
  • urinary symptoms
  • back pain
• pathophysiology
  • 95% prostatic adenocarcinoma
  • spread
    • local invasion
    • lymphatic spread
    • hematogenous spread
      • bone (90%)
  • use Gleason score
• investigation
  • ultrasound-assisted prostatic biopsy
  • local and whole-body staging
• treatment
  • depends on whether there is spread and if the patient is symptomatic
  • options include
    • radical prostatectomy
    • brachytherapy (insertion of radioactive rods into the prostate)
    • external beam radiotherapy

Role of imaging

• assist in a successful biopsy
• MR for local staging, e.g. is there extracapsular spread?
• whole-body staging

Radiographic features

Ultrasound

• a hypoechoic region in the periphery of the gland
• ultrasound-guided transrectal biopsy

MRI

• used for local staging
• determine whether tumor extends out with the prostatic capsule
• can be used to guide biopsy if the US-guided biopsy is negative

CT

• not useful for detection of in situ prostatic cancer
• can be useful to detect enlarged lymph nodes

Bone scan

• used for identifying distant bone metastases

PSMA PET-CT

• used for staging nodal and metastatic disease
• assist with radiotherapy planning
• detection of recurrence in patients with rising PSA post-treatment