DIAGNOSTICS

In order to diagnose the prostate cancer, patient should undergo per rectum tests (DRE), PSA concentration (prostate specific antigen) in blood serum should be determined, ultrasonography per rectum examination (TRUS - transrectal ultrasound) should be done and if there is a suspicion of prostate cancer, histopathological test of the material obtained through a per rectum thick-needle biopsy done under the ultrasound control should take place. Histopathological test is the only test that confirms the presence of cancerous cells in the prostate gland area. DRE, which is an examination of sensitivity of 80% sensitivity and of specificity of 60%, enables to seize changes in the area of the prostate such as consistency change, palpable nodules and hardenings. It is the base for sending a patient to a diagnostic biopsy. At present, it is believed that cytological diagnosis achieved through a fine-needle biopsy is not sufficient to make a right diagnosis. It results from the fact that the assessment according to Gleason’s classification is an important prognostic factor for the prostate cancer (see: prognostic factors). That is why a thick-needle biopsy is performed. Ultrasound use enables to take precise samples from suspicious foci. If there are no changes in TRUS picture, "sextant biopsy" is done (samples got for several places).

Recommendations for the biopsy of prostate gland: 1) palpable suspicion of the prostate cancer 2) PSA value over 15ng/ml regardless of DRE or TRUS tests 3) PSA value between 4 and 15 ng/ml with abnormalities detected during DRE or TRUS tests 4) PSA value exceeds the norm for a given age in the case of a positive family history regarding the prostate cancer

Recommendations for TRUS: 1) PSA between 4 and 12 ng/ml with abnormalities detected 2) questionable result of DRE test 3) necessity of a thick-needle biopsy Other diagnostic tests, such as CT and urography are not routinely performed because their value is questionable as far as the assessment of local stage and invasion of adjacent lymph nodes is concerned. Nowadays, magnetic resonance tomography done using transrectal coli (endorectal coil MRI - ERMR) to observe the prostate arouses great interest. Despite the increased sensitivity of the degree of the local stage, costs of the test do not allow for its routine use in the prostate cancer diagnosis. Scintigraphy of the skeleton is the most sensitive test (97%) in bone metastases detection. It is assumed that a patient with PSA under 10 ng/ml does not undergo scintigraphy because the probability of metastases is low.

Screening:

Screening: It is recommended that patients aged over 50 should undergo per rectum tests and PSA level tests every year.

PROGNOSTIC FACTORS:

Three groups of prognostic factors can be distinguished in the case of the prostate cancer:

1) development stage according to TNM 2) differentiation degree of the cancer based on the classification of Gleason and Mostofi 3) PSA level (prostate-specific antigen) in serum TNM classification

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