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| {{CMG}} | | __NOTOC__ |
| | {{CMG}} {{AE}} {{sali}} |
| {{Prostate cancer}} | | {{Prostate cancer}} |
| | ==Overview== |
| | Laboratory findings consistent with the diagnosis of prostate cancer include elevated serum [[prostate-specific antigen]] level, low [[red blood cell]] count, elevated [[blood urea nitrogen]] and [[creatinine]]. Some patients may have elevated concentration of serum [[calcium]] and [[alkaline phosphatase]], which is usually suggestive of [[bone metastases]]. |
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| ==Methods of Diagnosis== | | ==Laboratory findings== |
| ===Biopsy===
| | Laboratory findings consistent with the diagnosis of prostate cancer include:<ref>Diagnosing prostate cancer.2015 Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/prostate/diagnosis/?region=ab#Blood_chemistry_tests </ref> |
| {{main|Prostate biopsy}}
| | * Elevated serum [[prostate-specific antigen]] (PSA) level |
| If cancer is suspected, a biopsy is offered. During a biopsy a [[urology|urologist]] or [[radiology|radiologist]] obtains tissue samples from the prostate via the rectum. A biopsy gun inserts and removes special hollow-core needles (usually three to six on each side of the prostate) in less than a second. Prostate biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty-five percent of men report discomfort during prostate biopsy.<ref>{{cite journal| last=Essink-Bot| first=ML| coauthors=de Koning HJ, Nijs HG, Kirkels WJ, van der Maas PJ, Schroder FH| title=Short-term effects of population-based screening for prostate cancer on health-related quality of life| journal=J Natl Cancer Inst| year=1998| month=June 17| volume=90| issue=12| pages=925–31| pmid=9637143| doi=10.1093/jnci/90.12.925}}</ref>
| | * Low [[red blood cell]] count |
| | | * Elevated [[blood urea nitrogen]] (BUN) |
| ===Tumor markers===
| | * Elevated serum [[creatinine]] |
| {{main|Tumor markers}}
| | * Elevated [[alkaline phosphatase]] (indicating metastasis to bone) |
| Tissue samples can be stained for the presence of PSA and other tumor markers in order to determine the origin of maligant cells that have metastasized.<ref name="pmid17667550">{{cite journal |author=Chuang AY, Demarzo AM, Veltri RW, Sharma RB, Bieberich CJ, Epstein JI |title=Immunohistochemical Differentiation of High-grade Prostate Carcinoma From Urothelial Carcinoma |journal= The American Journal of Surgical Pathology|volume=31 |issue=8 |pages=1246–1255 |year=2007 |pmid=17667550 |doi=10.1097/PAS.0b013e31802f5d33}}</ref>
| | * Elevated [[calcium]] (indicating metastasis to bone) |
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| ===New tests being investigated===
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| Currently, an active area of research involves non-invasive methods of prostate tumor detection. Adenoviruses modified to transfect tumor cells with harmless yet distinct genes (such as luciferase) have proven capable of early detection. So far, though, this area of research has only been tested in animal and [[LNCaP]] models.<ref>Iyer M, Salazar FB, Lewis X, Zhang L, Wu L, Carey M and Gambhir SS. Non-invasive imaging of a transgenic mouse model using a prostate-specific two-step transcriptional amplification strategy. Transg Res.2005; 14(1): 47–55</ref>
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| ===PCA3===
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| Another potential non-invasive method of early prostate tumor detection is through a molecular test that detects the presence of cell-associated PCA3 mRNA in urine. PCA3 mRNA is expressed almost exclusively by prostate cells and has been shown to be highly over-expressed in prostate cancer cells. PCA3 is not a replacement for PSA but an additional tool to help decide if, in men suspected of having prostate cancer, a biopsy is really needed. The higher the expression of PCA3 in urine, the greater the likelihood of a positive biopsy, i.e. the presence of cancer cells in the prostate. Company [http://www.diagnocure.com/en/products-projects/prostate-cancer/prostate-cancer.php Diagnocure] has an exclusive worldwide license for all diagnostic and therapeutic applications related to PCA3
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| ===Early prostate cancer===
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| It was reported in April 2007 that a new blood test for [[early prostate cancer antigen-2]] (EPCA-2) is being researched that may alert men if they have prostate cancer and how aggressive it will be.<ref>[http://www.msnbc.msn.com/id/18328032/site/newsweek/ A Prostate Cancer Revolution]. Newsweek, April 26, 2007.</ref><ref name="pmid17437801">{{cite journal |author=Hansel DE, DeMarzo AM, Platz EA, ''et al'' |title=Early prostate cancer antigen expression in predicting presence of prostate cancer in men with histologically negative biopsies |journal=J. Urol. |volume=177 |issue=5 |pages=1736–40 |year=2007 |pmid=17437801 |doi=10.1016/j.juro.2007.01.013}}</ref>
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| ===Prostasomes===
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| Epithelial cells of the prostate secrete [[prostasomes]] as well as [[Prostate specific antigen|PSA]]. Prostasomes are membrane –surrounded, prostate-derived organelles that appear extracellularly and one of their physiological functions is to protect the sperm from attacks by the female immune system. Cancerous prostate cells continue to synthesize and secrete prostasomes and may be shielded against immunological attacks by these prostasomes. Research of several aspects of prostasomal involvement in prostate cancer has been performed.<ref>Ronquist G, Carlsson L, Larsson A, Nilsson BO: "Prostasomes: Proceedings from a symposium held at the Wenner-Gren Centre, Stockholm, June 2001" pp. 1-9. Portland Press , London
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| </ref>
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| ===Prostate mapping===
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| Prostate Mapping is a new diagnostic process developed by urology and radiology consultants in the UK. This is a method of diagnosis which may be accurate in determining the precise location and aggressiveness of cancer. It uses a combination of multi-sequence MRI imaging techniques and a template guided biopsy system and involves taking multiple biopsies through the skin that lies in front of the back passage rather than through the back passage. The procedure is carried out under [[general anesthetic]].
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| == Prostate: Adenocarcinoma (Gleason grading system)==
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| ===Gleason score===
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| {{main|Gleason score}}
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| The tissue samples are then examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features (or [[Gleason score]]) of any cancer found.
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| === Prostate: Adenocarcinoma (Gleason grade 1)===
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| {{#ev:youtube|F7V0Zl7a2FY}}
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| === Prostate : Adenocarcinoma (Gleason grade 2)===
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| {{#ev:youtube|YSOLiSklIXw}}
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| === Prostate : Adenocarcinoma (Gleason grade 3)===
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| {{#ev:youtube|TG8vR_pE7yA}}
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| === Prostate: Adenocarcinoma (Gleason grade 4)===
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| {{#ev:youtube|R2Cl4HScdGc}}
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| === Prostate: Adenocarcinoma (Gleason grade 5)===
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| {{#ev:youtube|F7V0Zl7a2FY}}
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| ==References== | | ==References== |
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| [[Category:Urology]] | | [[Category:Urology]] |
| [[Category:Types of cancer]] | | [[Category:Types of cancer]] |
| [[Category:Needs overview]]
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| [[Category:Primary care]]
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | [[Category:Urology]] |
| | [[Category:Up-To-Date]] |
| | [[Category:Oncology]] |
| | [[Category:Medicine]] |